回顾性比较Poser标准和McDonald标准

Retrospective comparison of the Poser criteria and the McDonald criteria

目的比较Poser标准和McDonald标准在多发性硬化诊断中的差异。方法对80例新诊断为多发性硬化患者的临床资料进行回顾性分析,分别应用Poser标准和McDonald标准对其进行诊断分类。结果80例患者中48例(60.00%)行脊髓MRI检查,阳性率为83.33%(40/48)。应用Poser标准,41例(51.25%)为临床确诊,10例(12.50%)为实验室确诊,17例(21.25%)为临床可能,余12例(15.00%)未能进行诊断分类。应用McDonald标准,45例(56.25%)为确诊多发性硬化,35例(43.75%)为可能多发性硬化。经Poser标准临床确诊的41例患者中,除4例不完全符合McDonald标准中确诊多发性硬化条件外,其余37例均符合;实验室确诊的10例患者中,4例符合McDonald标准中确诊多发性硬化条件,其余6例为可能多发性硬化。经McDonald标准确诊的45例患者中,37例符合Poser标准中临床确诊条件,4例为实验室确诊,1例为临床可能,余3例为原发进展型多发性硬化。18例患者(33.33%)脑脊液寡克隆区带检测阳性,26例(40.63%)IgG合成率升高。4例患者脑脊液寡克隆区带或IgG检测呈阳性反应且MRI病灶≥2个,经McDonald标准诊断为确诊多发性硬化。结论McDonald标准较Poser标准更为完善,尤其适用于原发进展型多发性硬化及临床孤立综合征患者。同时应用脊髓MRI检查以及脑脊液寡克隆区带和IgG检测有利于提高McDonald标准诊断的敏感性。

Objective To compare the difference between the Poser criteria and the McDonald criteria in the diagnosis of multiple sclerosis （MS）. Methods Eighty patients with new diagnosis of MS were analysed retrospectively, the Poser criteria and the McDonald criteria were used respectively for diagnostic classification. Results Among them, 48 patients （60.00%） had a spinal cord magnetic resonance imaging （MRI） and 83.33% （40/48） had abnormal presentations. According to the Poser criteria, 41 patients （51.25%） were classified as clinically definite, 10 patients （12.50%） as laboratory definite, 17 patients （21.25%） as clinically possible, and other 12 patients （15.00%） did not satisfy the requirements of any category in this criteria. According to the McDonald criteria, 45 patients （56.25%） were definite MS, 35 patients （43.75%） were possible MS. Of the 41 patients with clinically definite with the Poser criteria, 37 patients were definite MS with the McDonald criteria. Of the 10 patients with laboratory definite with the Poser criteria, 4 pateints were definite MS with the McDonald criteria, while other 6 patients were possible MS. Thirty-seven of 45 patients who were definite MS with the McDonald criteria were assigned to clinically definite with the Poser criteria, 4 patients were laboratory definite and one patient was clinically possible, while other 3 patients were diagnosed as primary progressive MS. Eighteen （33.33%） of 54 patients took cerebral spinal fluid （CSF）-OB test had a positive CSF, 26 （40.63%） of 64 patients took IgG test had a positive CSF. Four patients with CSF-OB/IgG （＋） with or more than 2 MRI lesions were diagnosed as definite MS with the McDonald criteria. Conclusion The McDonald criteria has more advantages than the Poser criteria, and is better to apply for patients with primary progressive MS and clinical isolated syndrome （CIS）. Using spinal cord MRI, and CSF-OB test and IgG test can improve the sensitivity of the McDonald criteria in clinical application.