用于监测复发性多发性硬化症病情改变治疗的视网膜层变薄--应用 "重塑 "概念的证据。

IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Multiple Sclerosis Journal Pub Date : 2024-08-01 Epub Date: 2024-08-07 DOI:10.1177/13524585241267257
Gabriel Bsteh, Harald Hegen, Nik Krajnc, Fabian Föttinger, Patrick Altmann, Michael Auer, Klaus Berek, Barbara Kornek, Fritz Leutmezer, Stefan Macher, Tobias Monschein, Markus Ponleitner, Paulus Rommer, Christiane Schmied, Karin Zebenholzer, Gudrun Zulehner, Tobias Zrzavy, Florian Deisenhammer, Franziska Di Pauli, Berthold Pemp, Thomas Berger
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引用次数: 0

摘要

背景:采用重新标定概念可减少光学相干断层扫描(OCT)测量视网膜层变薄的噪声:方法:我们从正在进行的前瞻性观察研究中纳入了复发性多发性硬化症(RMS)患者:在一项正在进行的前瞻性观察研究中,我们纳入了复发性多发性硬化症(RMS)患者,他们分别在疾病缓解治疗(DMT)开始时(基线)、基线后 6-12 个月(重定基线)和重定基线后⩾12 个月进行了 OCT 扫描。通过混合效应线性回归模型计算了从基线和重新基线开始的视网膜周神经纤维层(aLpRNFLbaseline/aLpRNFLrebaseline)和黄斑-网状细胞-加内复层(aLGCIPLbaseline/aLGCIPLrebaseline)的平均年化百分比损失率(%/年):我们纳入了173名RMS患者(平均年龄31.7岁(SD 8.8),72.8%为女性,中位病程15个月(12-94),中位基线至最后随访间隔37个月(18-71);56.6%为中效DMT(M-DMT),43.4%为高效DMT(HE-DMT))。平均 aLpRNFLbaseline 和 aLGCIPLbaseline 均显著增加,与基线前的复发(每次复发分别为 0.51% 和 0.26%,p < 0.001)和残疾恶化(分别为 1.10% 和 0.48%,p < 0.001)有关,但与 DMT 分级无关。相反,aLpRNFLrebaseline和aLGCIPLrebaseline均与基线前的复发或残疾恶化无关,而与M-DMT相比,HE-DMT显著降低了aLpRNFLrebaseline(0.31%,p < 0.001)和aLGCIPLrebaseline(0.25%,p < 0.001):结论:通过避免既往疾病活动带来的混杂因素,应用重基概念可显著提高 DMT 对视网膜层变薄影响的区分度。
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Retinal layer thinning for monitoring disease-modifying treatment in relapsing multiple sclerosis-Evidence for applying a rebaselining concept.

Background: Employing a rebaselining concept may reduce noise in retinal layer thinning measured by optical coherence tomography (OCT).

Methods: From an ongoing prospective observational study, we included patients with relapsing multiple sclerosis (RMS), who had OCT scans at disease-modifying treatment (DMT) start (baseline), 6-12 months after baseline (rebaseline), and ⩾12 months after rebaseline. Mean annualized percent loss (aL) rates (%/year) were calculated both from baseline and rebaseline for peripapillary-retinal-nerve-fiber-layer (aLpRNFLbaseline/aLpRNFLrebaseline) and macular-ganglion-cell-plus-inner-plexiform-layer (aLGCIPLbaseline/aLGCIPLrebaseline) by mixed-effects linear regression models.

Results: We included 173 RMS patients (mean age 31.7 years (SD 8.8), 72.8% female, median disease duration 15 months (12-94) median baseline-to-last-follow-up-interval 37 months (18-71); 56.6% moderately effective DMT (M-DMT), 43.4% highly effective DMT (HE-DMT)). Both mean aLpRNFLbaseline and aLGCIPLbaseline significantly increased in association with relapse (0.51% and 0.26% per relapse, p < 0.001, respectively) and disability worsening (1.10% and 0.48%, p < 0.001, respectively) before baseline, but not with DMT class. Contrarily, neither aLpRNFLrebaseline nor aLGCIPLrebaseline was dependent on relapse or disability worsening before baseline, while HE-DMT significantly lowered aLpRNFLrebaseline (by 0.31%, p < 0.001) and aLGCIPLrebaseline (0.25%, p < 0.001) compared with M-DMT.

Conclusions: Applying a rebaselining concept significantly improves differentiation of DMT effects on retinal layer thinning by avoiding carry-over confounding from previous disease activity.

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来源期刊
Multiple Sclerosis Journal
Multiple Sclerosis Journal 医学-临床神经学
CiteScore
10.90
自引率
6.90%
发文量
186
审稿时长
3-8 weeks
期刊介绍: Multiple Sclerosis Journal is a peer-reviewed international journal that focuses on all aspects of multiple sclerosis, neuromyelitis optica and other related autoimmune diseases of the central nervous system. The journal for your research in the following areas: * __Biologic basis:__ pathology, myelin biology, pathophysiology of the blood/brain barrier, axo-glial pathobiology, remyelination, virology and microbiome, immunology, proteomics * __Epidemology and genetics:__ genetics epigenetics, epidemiology * __Clinical and Neuroimaging:__ clinical neurology, biomarkers, neuroimaging and clinical outcome measures * __Therapeutics and rehabilitation:__ therapeutics, rehabilitation, psychology, neuroplasticity, neuroprotection, and systematic management Print ISSN: 1352-4585
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