背景:特发性急性横贯性脊髓炎(IATM)是一种脊髓局灶性炎症性疾病,可导致运动,感官,和自主神经功能障碍。然而,IATM患者的MRI阴性和MRI阳性的比较分析很少报道.
目的:本研究的目的是比较IATM患者MRI阴性和MRI阳性组,分析预后不良的预测因素,从而探讨MRI阴性与预后的关系。
方法:选取2018年5月至2022年5月南昌大学第一附属医院收治的132例首次发作的IATM患者。根据是否有脊柱MRI病变分为MRI阳性和MRI阴性组,根据随访时EDSS评分是否≥4,预后良好和预后不良。采用logistic回归模型分析IATM患者预后不良的预测因素。
结果:在132名患者中,107名符合IATM标准的首次发作患者被纳入研究。我们发现43例(40%)患者的脊髓MRI阴性,而27例(25%)患者被确定为预后不良(随访时EDSS评分≥4).与MRI阴性患者相比,MRI阳性组更有可能出现背部/颈部疼痛,脊髓休克和不良预后,随访时EDSS评分较高。我们还确定了不良结局的三个风险因素:缺乏二线治疗,最低点EDSS评分高,MRI结果阳性。
结论:与MRI阴性组相比,MRI阳性患者更有可能出现背部/颈部疼痛,脊髓休克和不良预后,随访时EDSS评分较高。没有二线治疗,在最低点EDSS得分高,MRI阳性是首次发作IATM患者预后不良的危险因素.MRI阴性患者预后较好,IATM患者的主动二线免疫治疗可能改善临床结局.
BACKGROUND: Idiopathic acute transverse myelitis (IATM) is a focal inflammatory disorder of the spinal cord that results in motor, sensory, and autonomic dysfunction. However, the comparative analysis of MRI-negative and MRI-positive in IATM patients were rarely reported.
OBJECTIVE: The purpose of this study was to compare MRI-negative with MRI-positive groups in IATM patients, analyze the predictors for a poor prognosis, thus explore the relationship between MRI-negative and prognosis.
METHODS: We selected 132 patients with first-attack IATM at the First Affiliated Hospital of Nanchang University from May 2018 to May 2022. Patients were divided into MRI-positive and MRI-negative group according to whether there were responsible spinal MRI lesions, and good prognosis and poor prognosis based on whether the EDSS score ≥ 4 at follow-up. The predictive factors of poor prognosis in IATM patients was analyzed by logistic regression models.
RESULTS: Of the 132 patients, 107 first-attack patients who fulfilled the criteria for IATM were included in the study. We showed that 43 (40%) patients had a negative spinal cord MRI, while 27 (25%) patients were identified as having a poor prognosis (EDSS score at follow-up ≥ 4). Compared with MRI-negative patients, the MRI-positive group was more likely to have back/neck pain, spinal cord shock and poor prognosis, and the EDSS score at follow-up was higher. We also identified three risk factors for a poor outcome: absence of second-line therapies, high EDSS score at nadir and a positive MRI result.
CONCLUSIONS: Compared with MRI-negative group, MRI-positive patients were more likely to have back/neck pain, spinal cord shock and poor prognosis, with a higher EDSS score at follow-up. The absence of second-line therapies, high EDSS score at nadir, and a positive MRI were risk factors for poor outcomes in patients with first-attack IATM. MRI-negative patients may have better prognosis, an active second-line immunotherapy for IATM patients may improve clinical outcome.