New cord lesions at follow-up by CSF profile.

BackgroundControversy exists about the radiological follow-up of the spinal cord in MS, since cord lesions are mostly symptomatic, but there are also reports that 10% − 25% are asymptomatic. Therefore, a need exists for biomarkers to identify patients prone to future cord involvement where routine cord imaging at follow-up is warranted. Elevated intrathecal IgM has been shown to be cross-sectionally associated with more cord lesions. This study investigated whether there also is a longitudinal relation.MethodsRelapse-onset MS patients with baseline CSF and spinal MRI available were retrospectively identified. Cross-sectional associations between intrathecal immunoglobulin production and cord lesions were assessed. For the subgroup where follow-up spinal MRIs were available, Andersen–Gill time-to-event models were used to estimate the risk of new cord lesions based on CSF makers and important covariates.Results394 patients had baseline CSF and cord imaging available, of which 253 had CSF and serum IgG data available, 139 IgM data and 138 both IgG and IgM data. At baseline, patients with intrathecal IgG (IgG IF+; 175 out of 253) and IgM production (IgM IF+; 44 out of 139) had more cord lesions (IgG IF+, mean 1.30 vs. 0.85 spinal cord lesions, p ConclusionWhile intrathecal IgM production is cross-sectionally independently associated with spinal cord lesions, this study does not support a role for predicting new cord lesions at follow-up.背景 关于多发性硬化（Multiple Sclerosis, MS）患者脊髓的影像学随访目前尚存争议：脊髓病灶多伴有临床症状，但亦有研究报道10%~25%的脊髓病灶为无症状性。因此，亟需找到可识别未来易出现脊髓受累患者的生物标志物，以明确此类患者是否需要接受常规脊髓随访影像学检查。既往研究已证实，鞘内IgM升高与横断面层面更多的脊髓病灶存在关联。本研究旨在探讨二者是否同样存在纵向关联。 方法 本研究回顾性纳入了具备基线脑脊液（Cerebrospinal Fluid, CSF）及脊髓磁共振成像（Magnetic Resonance Imaging, MRI）资料的复发起病型多发性硬化患者。首先评估了鞘内免疫球蛋白生成与脊髓病灶之间的横断面关联。针对具备随访脊髓MRI资料的亚组患者，本研究采用Andersen-Gill生存时间模型，基于脑脊液生物标志物及重要协变量，对新发脊髓病灶的风险进行估算。 结果 共计394例患者具备基线脑脊液及脊髓影像学资料，其中253例同时具备脑脊液与血清IgG数据，139例具备IgM数据，138例同时具备IgG与IgM数据。基线层面，鞘内IgG生成阳性（IgG IF+；253例中175例）及IgM生成阳性（IgM IF+；139例中44例）的患者脊髓病灶数量更多（IgG IF+组平均1.30个 vs. 0.85个脊髓病灶，P 结论 尽管鞘内IgM生成与脊髓病灶在横断面层面存在独立关联，但本研究未发现其可用于预测随访过程中新发脊髓病灶。