多发性硬化的轴索损害及其机制

Axonal damage and its mechanism in multiple sclerosis

目的:回顾多发性硬化轴索损害及其发病机制的研究结果,以便在此基础上对多发性硬化轴索损害更全面深入的了解和对该病的临床监测和治疗提供有效的理论指导。资料来源:应用计算机检索Medline1998-01/2005-01与多发性硬化轴索损害相关的文章,检索词为“multiplesclerosis,axonaldamageoraxonalinjury”,并限定文章语言种类为“English”,同时应用中国期刊全文数据CNKI检索1998-01/2005-01相关文章,检索词为“多发性硬化”和“轴索损害”,限定语言种类为中文。资料选择:选择与多发性硬化的轴索损害相关性强的文献46篇。资料提炼:在46篇文献中,选择32篇文献进行分类整理用于综述,其中20篇选用为参考文献,其余14篇因与入选文献内容呈不同程度重复给予删除。资料综合:对检索的文章进行分析综合显示,越来越多的证据表明多发性硬化的轴索损害出现在疾病早期,呈现出一种亚临床状态,在没有明显炎性活动的部位(如外观正常的白质组织)也存在轴索病变,而且在急性发作后缓解期和慢性期仍有进行性轴索损害,这可能是疾病进展的决定性因素。多发性硬化时轴索损害可由多种因素引起,但目前认为主要与炎症反应有关。结论:在多发性硬化的不同病程阶段均存在轴索损害,并且它是造成多发性硬化神经功能障碍的主要原因,轴索损害可由多种因素引起,但主要与炎症反应有关。

OBJECTIVE： Based on reviewing the results of study on the mechanism of tbe multiple sclerosis （MS） axonal damage, the global and further understand of the axonal damage of MS could be obtained so as to provide the effective theoretical guidance on the clinical monitoring and treatment of the disease. DATA SOURCES： An online search was carried out in Medline database and for relevant articles published from January 1998 to January 2005 by using the keywords of ＂multiple sclerosis, and axonal damage or axonal injury＂ in English. Meanwhile, related papers published between January 1998 and January 2005 were searched in China National Knowledge bffrastructure （CNKI） with the same key words in Chinese. STUDY SELECTION： Forty-six articles closely related with the axonal damage in multiple sclerosis were selected. DATA EXTRACTION： Among the 46 articles, 32 were classified and sorted for review, and 20 of them served for references, the other 14 were excluded because of repeated studies. DATA SYNTHESIS： The collected papers were analyzed and synthesized, and it was suggested that more and more evidences demonstrated that diffuse cerebral axonal damage began in the early stages of MS. The axonal damage was presented in both the active MS lesions and the non-inflammation lesions （for example normal-appearing white matter）. Even during clinical remitting and chronic stages of MS, which might be the key factor of disease progress. A lot of factors could lead to the axonal damage, but the inflammation was thought of the main cause. CONCLUSION： There is the axonal damage in each stage of MS, and the axonal damage is mainly responsible for neural functional disability of MS. A lot of factors can lead to the axonal damage, but the inflammation is thought of the main cause.