Multiple sclerosis and related disorders最新文献_第4页

Real-world COVID-19 immunity in multiple sclerosis (CoVaR-MS): A longitudinal follow up study 多发性硬化症患者真实世界COVID-19免疫（CoVaR-MS）：一项纵向随访研究

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-24 DOI: 10.1016/j.msard.2025.106947

Seema Kalra , David Jenkinson , Sarah Goddard , Krishna Banavathi , Omar Salim , Roby J Abraham , Kelvin P Jordan

COVID-19 vaccination in Multiple Sclerosis (MS) has continued clinical relevance. Complex dosing and variability in immunosuppression/ immunomodulation from disease modifying treatments (DMTs) necessitate real-world studies of COVID-19 immunity. We aimed to evaluate if PwMS develop adequate and persistent serological and cellular COVID-19 immunity after vaccination. We conducted a real-world longitudinal study (n = 235) including PwMS (n = 205; Alemtuzumab, Dimethyl fumarate, Fingolimod, Interferon, Natalizumab, Ocrelizumab, no-DMT) and Healthy volunteers (HV) (n = 30). Serological and cellular immunity was tested at ≤18 and ≤24-month after completed COVID-19 vaccine-course. 97 % of both HV and PwMS were immune at ≤18-month, and 96.9 % PwMS and 100 % HV at ≤24-month, (OR 0.33, 95 % CI (0.09, 0.93), p = 0.05)). Both groups showed similar cellular immunity at both timepoints. Vaccine Adverse effects incidence was similar too. PwMS on Ocrelizumab were significantly less likely to have low serological immunity (p < 0.001 at both timepoints). They were more likely to have intact T cell responses than HV (OR 5.4, 95 % CI 1.28-22.60). Despite this, they had higher infections per person year. PwMS on Fingolimod also had low serological immunity (Odd’s ratio 0.33; CI 0.11-0.97) which stayed low despite boosters and only 6 % showed intact cellular immunity, probably due to lymphopenia. Other DMT-treated PwMS (Natalizumab, Dimethyl Fumarate, Interferon, and no no-DMT) showed comparable COVID-19 serological and cellular immunity as HV. We report COVID-19 immunity clearly over time and across various DMT-groups. Ocrelizumab lowered serological but maintained cellular immunity; whilst Fingolimod lowered both. Data support boosters in PwMS, more so on Ocrelizumab and Fingolimod.

在多发性硬化症（MS）中接种COVID-19疫苗具有持续的临床意义。疾病修饰治疗（dmt）免疫抑制/免疫调节的复杂剂量和变异性需要对COVID-19免疫进行现实世界的研究。我们的目的是评估PwMS在接种疫苗后是否产生足够和持续的血清学和细胞COVID-19免疫。我们进行了一项真实世界的纵向研究（n = 235），包括PwMS (n = 205)；阿仑妥珠单抗、富马酸二甲酯、Fingolimod、干扰素、Natalizumab、Ocrelizumab、no-DMT)和健康志愿者（HV）（n = 30）。在完成COVID-19疫苗疗程后≤18个月和≤24个月进行血清学和细胞免疫检测。97%的HV和PwMS患者在≤18个月时免疫，96.9%的PwMS患者和100%的HV患者在≤24个月时免疫，（OR 0.33, 95% CI (0.09, 0.93), p = 0.05）。两组在两个时间点均表现出相似的细胞免疫。疫苗不良反应发生率也相似。使用Ocrelizumab的PwMS患者血清免疫低下的可能性显著降低（两个时间点的p <； 0.001）。他们比HV更有可能有完整的T细胞反应（OR 5.4, 95% CI 1.28-22.60）。尽管如此，他们每年的人均感染率更高。服用Fingolimod的PwMS血清免疫力也较低（Odd’s ratio 0.33; CI 0.11-0.97），尽管有增强剂，但仍保持较低水平，只有6%的PwMS表现出完整的细胞免疫，可能是由于淋巴细胞减少所致。其他dmt治疗的PwMS （Natalizumab、富马酸二甲酯、干扰素和无dmt）显示出与HV相当的COVID-19血清学和细胞免疫。我们清楚地报告了不同时间和不同dmt组的COVID-19免疫情况。Ocrelizumab降低血清学，但维持细胞免疫；而芬戈莫德把两个都放低了。数据支持PwMS的助推器，奥克雷单抗和Fingolimod更是如此。

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引用次数: 0

Screening for Biotinidase deficiency in children with spinal cord demyelination 脊髓脱髓鞘儿童生物素酶缺乏的筛查

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-24 DOI: 10.1016/j.msard.2025.106946

Maha Mohammed , Iman EL Agouza , Raghda Zaitoun , Khaled Ahmad , Shaimaa Mohammad , Ola Sallam , Hoda Tomoum

Introduction

Biotinidase deficiency (BD) is a disorder with autosomal recessive inheritance with protean clinical manifestations. Some cases present atypically with a neuroinflammatory phenotype that mimics neuromyelitis optica spectrum disorder. This can occur acutely in children who are otherwise normal leading to misdiagnosis and mismanagement with a potential for residual deficits.

Objective

To investigate biotinidase enzyme activity among children with presentation and radiological findings consistent with myelopathy.

Methods

This prospective observational study included children (≤18 years) admitted to the Pediatric Neurology Department, Ain Shams University Children’s Hospital, with myelopathy and MRI evidence of spinal cord demyelination. Clinical, laboratory, ophthalmological, and neuroimaging data were systematically collected. Serum biotinidase enzyme activity was measured in all participants.

Results

Thirty-nine children with spinal cord demyelination were included (44% male), with a median age at onset of 9 years. BD was identified in four patients. Presenting features included progressive limb weakness and gait disturbance, with optic neuropathy observed in three patients. Neuroimaging consistently demonstrated longitudinally extensive transverse myelitis involving the cervical and/or thoracic spinal cord, frequently accompanied by brainstem signal abnormalities. Prior to diagnosis, patients received immunomodulatory therapies with limited or transient benefit. Following biotin supplementation, all patients demonstrated clinical improvement, with residual deficits observed in those with delayed diagnosis.

Conclusion

BD should be considered in the differential diagnosis of pediatric spinal cord demyelination, particularly in antibody-negative cases or those with suboptimal response to immunotherapy. Further studies incorporating immune biomarkers are needed to determine whether adjunctive management of inflammation, alongside metabolic correction, may improve neurological outcomes.

生物素酶缺乏症（BD）是一种常染色体隐性遗传的疾病，临床表现多样。一些病例呈现非典型的神经炎症表型，模拟视神经脊髓炎谱系障碍。这可能会在其他方面正常的儿童中严重发生，导致误诊和管理不善，并可能存在残留缺陷。目的探讨脊髓病患儿临床表现和影像学表现的生物素酶活性。方法本前瞻性观察研究纳入Ain Shams大学儿童医院儿科神经内科收治的脊髓病和脊髓脱髓鞘MRI证据的儿童（≤18岁）。系统收集临床、实验室、眼科和神经影像学资料。测定所有受试者血清生物素酶活性。结果39例脊髓脱髓鞘患儿（44%为男性），发病年龄中位数为9岁。4例患者被确诊为BD。表现为进行性肢体无力和步态障碍，3例患者伴有视神经病变。神经影像学一致显示纵向广泛的横贯脊髓炎累及颈和/或胸脊髓，常伴有脑干信号异常。在诊断之前，患者接受免疫调节治疗，疗效有限或短暂。补充生物素后，所有患者均表现出临床改善，在延迟诊断的患者中观察到残留缺陷。结论小儿脊髓脱髓鞘的鉴别诊断应考虑bd，特别是在抗体阴性或免疫治疗反应不佳的病例中。需要进一步的研究纳入免疫生物标志物，以确定炎症的辅助管理，以及代谢纠正，是否可以改善神经系统预后。

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引用次数: 0

Neurological sequela of COVID-19 in adults with multiple sclerosis 成人多发性硬化症患者COVID-19的神经系统后遗症

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-23 DOI: 10.1016/j.msard.2025.106944

Anjali Patel , Christine Cherian , Derek Ge , Sabiha Hussain , Carol Shu , Michelle H. Chen , N3C consortium

Background

Possible interactions in neuropsychiatric presentations of multiple sclerosis (MS) and COVID-19 may occur, which has been proposed in previous, albeit limited, literature.

Objectives

Examine COVID-19 disease outcomes and changes in neuropsychiatric symptoms among patients with MS.

Methods

A retrospective cohort study using electronic medical records from the National COVID Cohort Collaborative (N3C) database was conducted. 26,963 adults with MS diagnosed with COVID-19 were included in the study, and propensity score matched to 80,889 neurologically healthy adults with COVID-19. Group differences in risk for general COVID-19 disease outcomes, 15 acute COVID-19-associated neuropsychiatric complications, and 6 chronic MS-associated neuropsychiatric symptoms were assessed.

Results

Patients with MS were at a higher risk for mortality; hospitalization; long-COVID diagnosis; more severe COVID-19 disease; 9 of the 15 acute complications, including cognitive impairment (OR: 4.059, p < 0.001), neuralgia (OR: 3.961, p < 0.001), dysautonomia (OR: 2.740, p < 0.008), and paresthesia (OR: 2.522, p < 0.001); and 5 of the 6 chronic symptoms, including cognitive impairment (OR: 2.945, p < 0.001), fatigue (OR: 2.190, p < 0.001), and depression (OR: 1.345, p < 0.001).

Conclusions

Patients with MS are at risk for adverse COVID-19 outcomes. This warrants heightened caution in this population when managing COVID-19 infections.

背景：多发性硬化症（MS）和COVID-19的神经精神表现可能发生相互作用，这在之前的文献中已经提出，尽管有限。目的探讨新型冠状病毒肺炎（COVID-19）患者的疾病结局和神经精神症状变化。方法采用美国国家COVID队列协作数据库（N3C）电子病历进行回顾性队列研究。26,963名诊断为COVID-19的MS成人纳入研究，倾向评分与80,889名患有COVID-19的神经健康成人相匹配。评估一般COVID-19疾病结局、15例急性COVID-19相关神经精神并发症和6例慢性ms相关神经精神症状风险的组间差异。结果多发性硬化症患者死亡风险较高；住院治疗;long-COVID诊断;更严重的COVID-19疾病；15例急性并发症中的9例，包括认知障碍（OR: 4.059, p < 0.001）、神经痛（OR: 3.961, p < 0.001）、自主神经异常（OR: 2.740, p < 0.008）和感觉异常（OR: 2.522, p < 0.001）；6种慢性症状中的5种，包括认知障碍（OR: 2.945, p < 0.001）、疲劳（OR: 2.190, p < 0.001）和抑郁（OR: 1.345, p < 0.001）。结论MS患者存在COVID-19不良结局的风险。因此，这一人群在管理COVID-19感染时应更加谨慎。

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引用次数: 0

Comment on “Relapse activity during pregnancy and the postpartum year is associated with accelerated disability progression in multiple sclerosis” 评论“妊娠期和产后一年的复发活动与多发性硬化症的加速残疾进展有关”

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-20 DOI: 10.1016/j.msard.2025.106938

Bhumesh Tyagi , Leelabati Toppo , Aishwarya Biradar

引用次数: 0

Perceived pain during isometric exercise and neuromuscular fatigability in individuals with multiple sclerosis 多发性硬化症患者在等长运动和神经肌肉疲劳时的感知疼痛

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-20 DOI: 10.1016/j.msard.2025.106943

Mitra Rouhani , Marie K. Hoeger Bement , Sandra K. Hunter , Kathleen M. Zackowski , Ahmed Z. Obeidat , Alexander V. Ng

Among people with multiple sclerosis (PwMS), pain is a common symptom, and neuromuscular fatigability is widely reported. However, the association between pain during exercise and neuromuscular fatigability remains unclear. This study aimed to identify the association between perceived pain and neuromuscular fatigability during an exercise task in PwMS. Thirty-two PwMS (age=56.4, females=15) and 15 age- and sex-matched non-MS controls (age=57.9, females=7) participated. Disease severity was evaluated using the Expanded Disability Status Scale (median EDSS=4.0). The experimental protocol involved maximal voluntary contractions (MVCs) of the dorsiflexors, time-to-task failure (TTF) of an isometric fatiguing exercise sustained at maximal strength (neuromuscular fatigability), and a post-exercise MVC. Central and peripheral fatigability were assessed using electrical stimulation. The twitch interpolation technique quantified voluntary activation (VA), with pre-to-post exercise reductions in VA indicating central fatigability. Pre-to-post exercise reductions in resting twitch amplitude indicated peripheral fatigability. Perceived pain (0–10) was assessed at rest prior to exercise, during, and immediately post-exercise. Associations of changes in pain perception were identified using Spearman’s correlation coefficient (rho). Despite no significant differences between PwMS and controls across all outcome measures (p > 0.2), compared to controls, PwMS with higher disease severity (n = 12, EDSS≥4.5) had a significantly shorter TTF (mean difference=-38.5 s, p = 0.04), higher central fatigability (11 percentage points, p = 0.01), and lower peripheral fatigability (-20.8%, p = 0.01). Among PwMS, smaller changes in pain perception correlated with increased neuromuscular fatigability (rho=0.5, p = 0.003), higher central fatigability (rho=-0.4, p = 0.05), and lower peripheral fatigability (rho=0.4, p = 0.03). These findings suggest that perceived pain during the exercise task may be an overlooked mechanism contributing to neuromuscular fatigability in PwMS.

在多发性硬化症（PwMS）患者中，疼痛是常见的症状，神经肌肉疲劳被广泛报道。然而，运动时疼痛与神经肌肉疲劳之间的关系尚不清楚。本研究旨在确定在PwMS运动任务中感知疼痛和神经肌肉疲劳之间的关系。32名PwMS（年龄=56.4，女性=15）和15名年龄和性别匹配的非ms对照组（年龄=57.9，女性=7）参与了研究。使用扩展残疾状态量表评估疾病严重程度（中位EDSS=4.0）。实验方案包括背屈肌的最大自愿收缩（MVCs），在最大强度（神经肌肉疲劳）下持续的等长疲劳运动的任务时间失败（TTF），以及运动后的MVC。使用电刺激评估中枢和外周疲劳。抽动插值技术量化了自愿激活（VA），运动前后VA的减少表明中枢疲劳。运动前后静息抽搐幅度的减少表明周围性疲劳。感知疼痛（0-10）分别在运动前、运动中和运动后进行评估。使用Spearman相关系数（rho）确定疼痛感知变化的关联。尽管PwMS和对照组在所有结局指标上没有显著差异（p > 0.2），但与对照组相比，疾病严重程度较高的PwMS （n = 12, EDSS≥4.5）的TTF显著缩短（平均差异=-38.5 s, p = 0.04），中心疲劳程度较高（11个百分点，p = 0.01），外周疲劳程度较低（-20.8%,p = 0.01）。在PwMS中，疼痛感知的较小变化与神经肌肉疲劳增加（rho=0.5, p = 0.003）、中枢疲劳增加（rho=-0.4, p = 0.05）和外周疲劳降低（rho=0.4, p = 0.03）相关。这些发现表明，在运动任务中感知到的疼痛可能是导致PwMS神经肌肉疲劳的一个被忽视的机制。

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引用次数: 0

Transfer of interferon beta in term placentae 足月胎盘中β干扰素的转移。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-20 DOI: 10.1016/j.msard.2025.106942

Eleanor Doman , Angelos Evangelinos , Lewis Renshall , Ruth Dobson , Paul Brownbill

Objective

An increased risk of relapse is seen postpartum in women with multiple sclerosis (MS), suggesting treatment with disease modifying therapy may be considered during pregnancy. Cohort studies on the safety of interferon beta (IFN-β) during pregnancy are skewed towards early pregnancy. Here we use laboratory tests to study the transfer of IFN-β in the term placenta.

Methods

Using term placental tissue (n=3) we conducted ex vivo dual placental perfusions over 6 hours, adding IFN-β to the maternal circulation and sampling the fetal circulation to determine its transfer.

Results

Minimal transfer between the maternal and fetal circulation was observed with the maximum transfer across all three experiments <0.03% of the maximum maternal concentration.

Discussion

This study provides additional evidence to support the consideration of use of IFN-β based MS medications in pregnancy. The minimal transfer in the term placenta provides reassurance to people with MS and medical professionals considering the use of medication during the third trimester.

目的：多发性硬化症（MS）妇女产后复发的风险增加，提示在怀孕期间可以考虑使用疾病调节治疗。关于妊娠期间干扰素β (IFN-β)安全性的队列研究倾向于早期妊娠。在这里，我们使用实验室测试来研究IFN-β在胎盘期的转移。方法：利用足月胎盘组织（n=3）进行体外双胎盘灌注6小时，向母体循环中添加IFN-β，并对胎儿循环进行取样，以确定其转移情况。结果：在所有三个实验中，母体和胎儿循环之间的转移最小，而转移最大。讨论：本研究提供了额外的证据，支持考虑在妊娠期间使用基于IFN-β的MS药物。胎盘的最小转移为MS患者和考虑在妊娠晚期使用药物的医疗专业人员提供了保证。

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引用次数: 0

SPHERES: innovative registry addressing the new era of neuromyelitis optica spectrum disorders (NMOSD) therapy SPHERES：解决视神经脊髓炎频谱障碍（NMOSD）治疗新时代的创新注册。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-19 DOI: 10.1016/j.msard.2025.106940

Jeffrey L. Bennett , Nicole Middaugh , Michael R. Yeaman , Terry J. Smith , Megan K. Behne , Margaux Crabtree , Robert R. McLean , Dimitros A. Pappas , Michael Levy

Neuromyelitis Optica Spectrum Disorders (NMOSD) are rare, autoimmune disorders of the central nervous system (CNS) that affect optic nerves and spinal cord. The SPHERES (Synergy of Prospective Health & Experimental Research for Emerging Solutions) Registry for NMOSD, a prospective observational cohort of adult patients in the United States, established in June 2021, was designed to gather robust and high-quality longitudinal data to facilitate knowledge of NMOSD and better understand the newly approved therapeutics. The objective of this study was to detail the SPHERES Registry features and characterize the SPHERES population in aggregate and stratified by serostatus at registry enrollment. Registry questionnaires were completed by clinicians and patients at enrollment and at routine clinical visits occurring at ∼6-month intervals, with additional data collection between visits. At enrollment into SPHERES, mean age of the first 350 patients enrolled was 50.1 years, 84 % of the cohort was female, 66 % had anti-AQP4+ NMOSD, and 71 % reported use of a biologic therapy. A number of demographic and disease characteristics and disease activity measures varied by serostatus, including mean durations since symptom onset and diagnosis and mean EDSS score. Patient-reported outcome measures were generally similar across serostatus groups. This analysis of the initial SPHERES patients provides valuable insights into the ability of the Registry to capture the natural history, real-world effectiveness, therapeutic utilization and safety in treating NMOSD.

视谱神经脊髓炎（NMOSD）是一种罕见的中枢神经系统（CNS）自身免疫性疾病，影响视神经和脊髓。NMOSD的SPHERES（新兴解决方案前瞻性健康与实验研究协同）登记处是一项针对美国成年患者的前瞻性观察队列，于2021年6月成立，旨在收集可靠和高质量的纵向数据，以促进对NMOSD的认识，并更好地了解新批准的治疗方法。本研究的目的是详细描述SPHERES登记的特征，并根据登记入组时的血清状态对SPHERES人群进行总体和分层。注册问卷由临床医生和患者在入组时以及每隔6个月的常规临床就诊时完成，并在两次就诊之间收集额外的数据。在入组SPHERES时，前350名患者的平均年龄为50.1岁，84%为女性，66%有抗aqp4 + NMOSD， 71%报告使用了生物治疗。许多人口统计学和疾病特征以及疾病活动性测量因血清状态而异，包括自症状出现和诊断以来的平均持续时间以及平均EDSS评分。不同血清状态组患者报告的结果通常相似。对最初的SPHERES患者的分析提供了宝贵的见解，使其能够了解治疗NMOSD的自然历史、现实世界的有效性、治疗利用率和安全性。

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引用次数: 0

Is newly diagnosed multiple sclerosis a medical emergency? 新诊断的多发性硬化症是医疗紧急情况吗？

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-19 DOI: 10.1016/j.msard.2025.106939

H El Mouhajir , A Alrashed , B Mohamed , K Schmierer

引用次数: 0

Development of a machine learning model to predict the expanded disability status scale in multiple sclerosis patients 开发一种机器学习模型来预测多发性硬化症患者扩展的残疾状态量表。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-18 DOI: 10.1016/j.msard.2025.106937

Asiye Tuba Ozdogar , Murat Emec , Ergi Kaya , Ela Simay Zengin , Mehmet Hilal Ozcanhan , Serkan Ozakbas

Objective

The assessment of disability in multiple sclerosis (MS) patients is crucial for treatment decisions and prognosis estimation. The Expanded Disability Status Scale (EDSS) provides a standardized way to quantify disability in MS. However, predicting EDSS scores can be challenging due to the complex and heterogeneous nature of the disease. Machine learning techniques offer a promising approach to predict EDSS scores based on various patient characteristics.

Methods

231 people with MS (pwMS) who had an assessment of physical, psychosocial, and cognitive functions in three timelines (baseline (T0), first year (T1), and second year (T2)) were enrolled. The dataset used for the study consists of 126 features. Feature selection was based on feature saliency and correlation analysis. Three machine learning models —XGBoost, Random Forest, and Linear Regression —were trained on the selected features. Hyperparameter tuning was also carried out on the models. Model performance was evaluated using standard evaluation metrics, including MAE, MSE, and R².

Results

The Machine Learning model based on the XGBoost algorithm performed best in predicting EDSS scores (T2). The MAE value obtained with the XGBoost model is 0.2361, the MSE value is 0.2408, and the R2 value is 0.9705. These results indicate that XGBoost's predictive ability on the current dataset is promising.

Conclusion

Our study demonstrates the feasibility of using machine learning techniques to predict EDSS scores in MS patients. The developed models show promising performance and have the potential to enhance clinical decision-making and patient management in MS care.

目的：评估多发性硬化症（MS）患者的残疾对治疗决策和预后评估至关重要。扩展残疾状态量表（EDSS）提供了一种标准化的方法来量化多发性硬化症的残疾。然而，由于该疾病的复杂性和异质性，预测EDSS评分可能具有挑战性。机器学习技术提供了一种很有前途的方法来预测基于各种患者特征的EDSS评分。方法：231名多发性硬化症（pwMS）患者在三个时间线(基线（T0）、第一年（T1）和第二年（T2）进行了身体、社会心理和认知功能评估。该研究使用的数据集由126个特征组成。特征选择基于特征显著性和相关性分析。三个机器学习模型——xgboost、随机森林和线性回归——在选定的特征上进行了训练。对模型进行了超参数整定。采用标准评价指标，包括MAE、MSE和R²对模型性能进行评价。结果：基于XGBoost算法的机器学习模型在预测EDSS评分（T2）方面表现最好。使用XGBoost模型得到的MAE值为0.2361，MSE值为0.2408，R2值为0.9705。这些结果表明，XGBoost在当前数据集上的预测能力是有希望的。结论：我们的研究证明了使用机器学习技术预测MS患者EDSS评分的可行性。所开发的模型显示出良好的性能，并有可能提高MS护理的临床决策和患者管理。

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引用次数: 0

Black and Non-Hispanic White persons with multiple sclerosis: Social determinants of health and health inequities 患有多发性硬化症的黑人和非西班牙裔白人：健康和健康不平等的社会决定因素

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2025-12-16 DOI: 10.1016/j.msard.2025.106935

Marta Ponzano , Nicole Graziano , Claire Wigley , Giacomo Boffa , Sylvia Klineova , Maria Petracca , Claire Riley , Jonathan Howard , Maria Pia Sormani , Matilde Inglese , Fred Lublin

Objective

Distinctive differences in multiple sclerosis (MS) disease severity, progression, and mortality have been observed among different races. Social determinants of health (SDH) can contribute to such racial disparities. This study aims to: 1) compare Non-Hispanic White (NHW) and Black (Bl) persons with MS in terms of MS and SDH; 2) explore the impact of SDH-adjustment in the association between race and Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25-FW), 9-Hole Peg Test (9-HPT), Symbol Digit Modalities Test (SDMT).

Methods

120 patients, self-identified as Bl (n = 60) or NHW (n = 60) persons, were included in this cross-sectional analysis from a prospectively enrolled cohort. We used parametric and non-parametric tests; logistic models were performed to select the most relevant SDH. Univariable linear regression models were used to explore differences in EDSS, T25-FW, 9-HPT, SDMT and models were adjusted for relevant SDH using propensity scores (PS).

Results

Significant racial disparities in adverse SDH were identified in Black persons with MS (BpwMS). BpwMS patients had a higher EDSS (β=0.66, p = 0.022), log-transformed T25-FW (β=0.16, p = 0.001), 9-HPT (β=2.89, p = 0.001) and lower SDMT (β=-5.97, p = 0.003); after PS-adjustment, associations were no longer significant except for T25-FW (β=0.13, p = 0.030) and the magnitude of all coefficients was reduced (EDSS: -27 %, T25-FW: -19 %, 9-HPT: -36 %, SDMT: -45 %).

Interpretation

More efforts are necessary to adequately address the SDH that distinguish Bl from NHW persons with MS; additional unknown or unmeasured variables, including biologic differences as well as other SDH, should be explored to elucidate the mechanisms behind worse MS outcomes in BpwMS.

目的观察不同种族在多发性硬化症（MS）疾病严重程度、进展和死亡率方面的显著差异。健康的社会决定因素可能助长这种种族差异。本研究旨在：1)比较非西班牙裔白人（NHW）和黑人（Bl） MS患者在MS和SDH方面的差异；2)探讨sdh -调整在种族与扩展残疾状态量表（EDSS）、定时25英尺步行（T25-FW）、9孔挂钩测验（9-HPT）、符号数字模式测验（SDMT）之间的关联中的影响。方法从前瞻性入组队列中选取120例自称为Bl （n = 60）或NHW （n = 60）的患者进行横断面分析。我们使用参数和非参数测试；运用逻辑模型选择最相关的SDH。采用单变量线性回归模型探讨EDSS、T25-FW、9-HPT和SDMT的差异，并使用倾向得分（PS）对模型进行相关SDH调整。结果黑人多发性硬化症（BpwMS）患者的不良SDH存在显著的种族差异。BpwMS患者的EDSS （β=0.66, p = 0.022）、T25-FW （β=0.16, p = 0.001）、9-HPT （β=2.89, p = 0.001）和SDMT （β=-5.97, p = 0.003）均较高；ps调整后，除T25-FW （β=0.13, p = 0.030）外，所有系数的大小均降低（EDSS: - 27%, T25-FW: - 19%, 9-HPT: - 36%, SDMT: - 45%）。需要更多的努力来充分解决区分Bl和NHW的MS患者的SDH；应该探索其他未知或未测量的变量，包括生物学差异以及其他SDH，以阐明BpwMS恶化的MS结果背后的机制。

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