慢性脑-脊髓静脉功能不全在炎性脱髓鞘疾病中作用的初步研究

Effect of chronic cerebrospinal venous insufficiency in the pathogenetic mechanisms of inflammatory demyelinating diseases

目的本研究探讨我国多发性硬化(MS)和视神经脊髓炎(NMO)患者是否存在慢性脑-脊髓静脉功能不全(CCSVI)。方法入组MS患者10例、NMO和NMO谱系疾病(NMOSD)患者9例。所有患者均进行无创性颅外静脉超声检查,以观察静脉反流、颈内静脉(IJVs)横径(CSA)绝对值和IJVs的CSA差值。患者如果同意则进一步行选择性静脉血管造影(DSA)检查,观测IJVs和奇静脉(AZY)狭窄程度、跨壁压及侧支循环开放情况。选择年龄匹配的健康体检者20名为对照,均进行无创性超声检查。结果 (1)静脉超声检查显示,MS及NMOSD患者出现不同程度IJVs和椎静脉(VVs)反流,10例MS中5例出现左侧IJVs反流;8例患者出现右侧IJVs反流;2例患者出现左侧VVs反流;5例出现右侧VVs反流。NMOSD患者也出现IJVs和VVs反流,但均未达到Zamboni的标准,提示MS患者反流可能更加明显。与对照组(0.226±0.078)比较,MS(0.132±0.146,P=0.028)和NMOSD(0.134±0.077,P=0.007)患者右侧IJVs坐位CSA缩短。(2)3例缓解-复发型MS(RRMS)及2例长节段脊髓炎(LEM)患者进行了静脉DSA检查,其中1例RRMS(AZY开口处狭窄约75%)及1例LEM患者(AZY开口处狭窄约64%)均出现静脉狭窄及侧支循环开放。结论部分MS患者及NMOSD患者存在经超声及DSA证实的CCSVI。

Objective Chronic cerebrospinal venous insufficiency（CCSVI）is involved in pathogenetic mechanisms of multiple sclerosis（MS）and other inflammatory demyelinating diseases.However,CCSVI in MS and neuromyelitis optica（NMO）have not previously been investigated in China.Methods Ten MS patients,9NMO（and NMOSD）patients were enrolled.Extracranial venous ultrasonography was taken in all patients.Observation indexes including venous reflux,cross sectional area（CSA）of internal jugular veins（IJVs）,and changes in IJVs CSA（△CSA）.In addition,some of the patients underwent digital subtraction angiography（DSA）to detect stenosis of IJVs and azygous vein（AZY）.Extracranial venous ultrasonography was also taken in 20age-match healthy controls.Results（1）Extracranial venous ultrasonography revealed that backstreaming in IJVs and vertebral vein（VVs）were significnatly associated with MS and NMO,and this association was much more significant in MS than NMO.CSA of IJVs on right-sidedness in sitting position of MS（P=0.028）and NMO（P=0.007）patients were obvious descend compared with controls.（2）DSA confirmed that narrow in VVs and collateral circulation were seen in MS and NMO patients.Conclusions Evaluated using ultrasonography and DSA,this study confirmed CCSVI in some MS and NMO patients.