| Abstract | Cilj istraživanja: Cilj ovog istraživanja je provjeriti koliko je bilo novodijagnosticiranih slučajeva demijelinizacijske bolesti u Klinici za neurologiju KBC-a Split u 2019. godini, posebno slučajeva multiple skleroze (MS) i nespecificirane demijelinizacijske bolesti (DB), dobiti uvid u epidemiološke i kliničke značajke njihove bolesti te analizirati dobivene rezultate između ove dvije skupine i usporediti ih s rezultatima i zaključcima drugih svjetskih i nacionalnih istraživanja.
Materijali i metode: Uzorak potreban za provedbu istraživanja dobiven je retrospektivnim pregledom arhive Klinike za neurologiju KBC-a Split prilikom pretraživanja medicinske dokumentacije svih pacijenata hospitaliziranih na klinici u 2019. godini. Kriteriji uvrštavanja su da su pacijenti hospitalizirani u navedenom razdoblju te im je tada prvi put postavljena dijagnoza demijelinizacijske bolesti ili multiple skleroze. Ulazni parametri za statističku obradu su: dob pri postavljenoj dijagnozi, spol, trajanje simptoma do javljanja na prvi pregled, vrsta simptoma, vrijeme od dokumentiranja simptoma do postavljanja dijagnoze, uobičajene laboratorijske i imunološke pretrage krvi, rutinski pregled likvora (leukociti i ukupni proteini), virusološke pretrage likvora, tip oligoklonskih traka, RTG pluća, pregled očne pozadine, nalaz pretrage vidnih evociranih potencijala, nalaz MR-a (broj lezija i njihova aktivnost), EDSS status za skupinu s multiplom sklerozom i komorbiditeti bolesnika.
Rezultati: U 2019. godini u Klinici za neurologiju KBC-a Split novodijagnosticiranih je 45 slučajeva demijelinizacijske bolesti, od čega 30 slučajeva multiple skleroze i 15 slučajeva nespecificirane demijelinizacijske bolesti. U cijelom uzorku omjer žena i muškaraca je 2.46:1, a medijan dobi je 40 godina (IQR 29-48). U MS skupini je medijan dobi manji, 36 godina (IQR 29-47). Bolesnici iz DB skupine imaju 8 godina više pri dijagnozi. Početni simptomi bolesnika u cijelom uzorku traju 22 dana (IQR 10-60); u MS skupini 19 dana (IQR 7-90), a u DB skupini 37 dana (IQR 11-60). Najčešće su kombinacija senzornih, motoričkih ili vidnih ispada. Vrijeme od dokumentiranja simptoma do postavljanja dijagnoze ima središnju vrijednost od 2 mjeseca (IQR 1-4). Medijan EDSS statusa u MS skupini je 1.5 (IQR 1-2). Laboratorijski nalazi uobičajenih i imunoloških krvnih pretraga su u više od polovine slučajeva bili uredni. U rutinskom pregledu likvora središnja vrijednost broja leukocita za MS skupinu iznosi 2.5 x 10^6 /L, a za DB skupinu 1 x 10^6 /L. Središnja vrijednost za ukupne proteine u likvoru iznosi u MS skupini 390 mg/L (IQR 305-488), a u DB skupini 337 mg/L (IQR 294-379). Dakle, bolesnici s multiplom sklerozom češće imaju povišene proteine. Virusološke pretrage likvora su u 53.33% bolesnika MS skupine pozitivne, a u DB skupini su mahom negativne (93.33%). Tip oligoklonskih traka koji dominira u cijelom uzorku i u MS skupini (76.67%) je tip 2. Za DB skupinu najčešći je tip 1 (80%). Među svim bolesnicima dominira patološki nalaz vidnih evociranih potencijala, i to više u MS skupini. U obje skupine je kod svih bolesnika nalaz pregleda očne pozadine i RTG-a pluća uredan. Kod gotovo svih je nađen pozitivan nalaz MR-a mozga (97.77%). U MS skupini najčešće imaju više od 10 lezija (40%) te u trećini slučajeva imaju aktivne lezije. U DB skupini ih većina ima do 4 lezije (46.67%), a aktivnost je zabilježena u samo 13.33% slučajeva. Na MR-u kralježnične moždine čak 61.9% svih bolesnika nije imalo lezije. Svi ostali imaju najčešće lezije u cervikalnim segmentima, a najrjeđe u torakalnim. U MS skupini su imali najčešće do 4 lezije (41.38%), a od toga 57.14% aktivne. U DB skupini ih je samo 15.38% imalo lezije, od toga polovina aktivne. Bolesnici s dijagnozom DB imaju učestalije komorbiditete u odnosu na one s MS dijagnozom (najčešće su cervikalna i lumbalna diskopatija te cerebrovaskularna bolest).
Zaključci: Većina bolesnika s novodijagnosticiranom demijelinizacijskom bolesti u KBC-u Split tijekom 2019. godine imala je multiplu sklerozu. Bolest je češća u žena, mlađe do srednje životne dobi koje se ranije javljaju na prvi pregled. Među nalazima pretraga likvora povećana je vrijednost ukupnih proteina, prevladavaju oligoklonske trake tip 2, kao i pozitivan nalaz virusoloških pretraga. Vidni evocirani potencijali uglavnom su patološki te bolesnici imaju više lezija na mozgu nego u kralježničnoj moždini. Kod bolesnika s nespecificiranom demijelinizacijskom bolešću žene su još brojnije, s češćim komorbiditetima, a intratekalna sinteza i virusološke pretrage likvora su uglavnom negativne. U manjem broju slučajeva imaju lezije na mozgu, a u kralježničnoj moždini vrlo rijetko. |
| Abstract (english) | Objectives: The aim of this study is to verify how many cases of newly diagnosed demyelinating disease was there in the Clinic of Neurology in KBC Split in 2019., especially cases of multiple sclerosis (MS) and unspecified demyelinating disease (DB), to get the insight into the epidemiological and clinical features of their disease, to analyze the obtained results between these two groups and to compare them with results and conclusions of other world and national researches.
Patients and Methods: The sample needed for the implementation of our research was obtained by retrospectively reviewing the archives of the Clinic of Neurology in KBC Split during a search of medical records of all patients hospitalized at the clinic in 2019. The criteria of inclusion were that the patients were hospitalized during this year and that they were then diagnosed with demyelinating disease or multiple sclerosis for the first time. Input parameters for statistical analysis were: age at diagnosis, gender, duration of symptoms until first examination, type of symptoms, time from documenting symptoms to diagnosis, routine laboratory and immunological blood tests, routine examination of cerebrospinal fluid (leukocytes and total proteins count), virological testing of cerebrospinal fluid, oligoclonal bands type, lung X-ray findings, ocular fundus examination, visual evoked potentials results, MR findings (number of lesions and their activity), EDSS status for the multiple sclerosis group and patient comorbidities.
Results: In 2019, 45 cases of demyelinating disease were newly diagnosed at the Clinic of Neurology in KBC Split, of which 30 cases of multiple sclerosis and 15 cases of unspecified demyelinating disease. In the whole sample, the ratio of women to men is 2.46: 1, and the median age is 40 years (IQR 29-48). In the MS group, the median age was lower, 36 years (IQR 29-47). Patients from the DB group are 8 years older at diagnosis. The initial symptoms of the patients in the whole sample last for 22 days (IQR 10-60); in the MS group 19 days (IQR 7-90) and in the DB group 37 days (IQR 11-60). They are most often a combination of sensory, motor and visual symptoms. The time from documenting symptoms to diagnosis has a median of 2 months (IQR 1-4). The median EDSS status in the MS group was 1.5 (IQR 1-2). Laboratory findings of routine and immunological blood tests were normal in more than half of the cases. In routine cerebrospinal fluid examination, the median leukocyte count for the MS group is 2.5 x 10 ^ 6 /L and for the DB group 1 x 10 ^ 6 /L. The median value for total cerebrospinal fluid proteins is 390 mg/L in the MS group (IQR 305-488) and 337 mg/ L (IQR 294-379) in the DB group. Thus, patients with multiple sclerosis are more likely to have elevated proteins. Virological tests of cerebrospinal fluid were positive in 53.33% of patients in the MS group and mostly negative in the DB group (93.33%). The type of oligoclonal bands that dominates the whole sample and in the MS group (76.67%) is type 2. For the DB group, type 1 (80%) is the most common. Among all patients, the pathological finding of visual evoked potentials dominates, especially in the MS group. In both groups, ocular fundus examination and X-ray of the lungs were normal in all patients. A positive MRI of the brain was found in almost all of them (97.77%). In the MS group, they usually have more than 10 lesions (40%) and in a third of cases they have active lesions. In the DB group, most of them have up to 4 lesions (46.67%) but activity was recorded in only 13.33% of cases. On spinal MRI even 61.9% of all patients had no lesions. The rest of them have the most common lesions in the cervical segments, and the least common in the thoracic segments. In the MS group, they most often had up to 4 lesions (41.38%), of which 57.14% were active. In the DB group, only 15.38% had lesions, half of which were active. Patients diagnosed with DB have more frequent comorbidities compared to those diagnosed with MS (most commonly cervical and lumbar discopathy and cerebrovascular disease).
Conclusions: The majority of patients with newly diagnosed demyelinating disease at the KBC Split in 2019 had multiple sclerosis. The disease is more common in women, younger to middle-aged, who go earlier for the first examination. In findings of cerebrospinal fluid tests, the value of total proteins is increased, type 2 oligoclonal bands predominate, as well as a positive finding of virological tests. Visual evoked potentials are mostly pathological and patients have more lesions in the brain than in the spinal cord. In patients with unspecified demyelinating disease, there are even more women, with more frequent comorbidities, but intrathecal synthesis and virological tests of cerebrospinal fluid are mostly negative. In a minority of cases they have lesions on the brain, and in the spinal cord very rarely. |
