2017修订版McDonald多发性硬化诊断标准解读

Comments on 2017 revision of McDonald criteria for the diagnosis of multiple sclerosis

2010修订版McDonald多发性硬化(multiple sclerosis,MS)诊断标准被广泛应用于研究和临床实践。结合近年来的科学研究进展,MS诊断国际专家组在2010修订版McDonald MS诊断标准的基础上,提出了新的2017修订版McDonald MS诊断标准。主要修订内容包括:典型的临床孤立综合征(clinically isolated syndrome,CIS)患者,如已有临床或磁共振成像(magnetic resonance imaging,MRI)的空间多发证据,且脑脊液(cerebrospinal fluid,CSF)特异的寡克隆区带阳性,即允许MS诊断成立;在幕上和幕下病灶或脊髓综合征患者中,症状性病灶可用于空间和时间多发证据;皮质病灶可用于空间多发证据。2017修订版McDonald MS诊断标准更加简化和明晰,有利于MS的早期诊断;同时保留了2010修订版的特异性,旨在促进其在不同人群中的合理应用以降低误诊率。本文对2017修订版McDonald MS诊断标准的要点进行解读和评论。

The 2010 revision of McDonald criteria for the diagnosis of multiple sclerosis(MS) has widely used in research and clinical practice.By combining the progress in scientific research in recent years,the international panel on diagnosis of multiple sclerosis reviewed the 2010 revision of McDonald criteria and recommended new revisions.The following changes have been made: in patients with a typical clinically isolated syndrome(CIS) and clinical or magnetic resonance imaging(MRI) demonstration of dissemination in space,the presence of cerebrospinal fluid(CSF)-specifc oligoclonal bands allows a diagnosis of MS; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial and infratentorial lesions or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space.The 2017 revision of McDonald criteria is intended to simplify or clarify components of the 2010 revision of McDonald criteria,so as to facilitate earlier diagnosis.The 2017 revision of McDonald criteria also preserves the specificity of 2010 revesion,and promotes its appropriate application in diverse population to reduce the frequency of misdiagnosis.This paper presents the highlights of 2017 revision of McDonald criteria for the diagnosis of MS and gives some comments.