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多发性硬化症的诊断和治疗:一篇综述
Marisa P McGinley1, Carolyn H Goldschmidt1, Alexander D Rae-Grant1,2
1Cleveland Clinic Mellen Center, Cleveland, Ohio.
JAMA
|February 23, 2021
概括
多发性硬化 (MS) 是一种中枢神经系统疾病, 目前的疾病修饰疗法 (DMT) 可以显著减少MS患者的复发率和MRI病变.
科学领域:
- 神经免疫学
- 神经退行性疾病
背景情况:
- 多发性硬化症 (MS) 是一种影响中枢神经系统的自身免疫性疾病,导致脱髓化和轴突损伤.
- 在美国,大约有900,000人患有多发性硬化,通常发生在年轻人中 (20-30岁),造成身体和认知障碍.
- 这种疾病的全球患病率因度而异,女性患病率不成比例 (几乎为3:1).
研究的目的:
- 审查有关多发性硬化症诊断和治疗的现有证据.
- 总结可用的疾病修饰疗法 (DMT) 的疗效和不良影响.
主要方法:
- 诊断依赖于临床表现,MRI发现 (T2病变) 和脑脊液分析 (寡克隆带),遵循2017年麦克唐纳标准.
- 对9类复发性缓解性多发性硬化和具有活性的二次进展性多发性硬化药物的审查,包括干扰素,格拉蒂拉默酸盐和单克隆抗体.
- 在初级渐进型多发性硬化症中包括ocrelizumab.
主要成果:
- 与安慰剂或活性比较剂相比,DMT在降低年复发率方面表现出29% - 68%的有效性.
- 用DMT治疗也减少了MRI上的新的T2病变和加多增强病变.
- 与DMT相关的不良反应包括感染,心血管问题,输液/注射部位反应和二次自身免疫性疾病.
结论:
- 多发性硬化症由于身体残疾和认知障碍而显著影响生活质量.
- 疾病修饰疗法在控制多发性硬化症活动,减少复发和病变进展方面具有显著的益处.
- 持续的DMT研究和开发对于改善多发性硬化患者的长期结果至关重要.
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