urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2021-20-6-57-62urmj-910Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПрогнозирование рецидива при демиелинизирующих заболеваниях у детейPredicting relapse in demyelinating diseases in childrenhttps://orcid.org/0000-0003-0643-6094НевмержицкаяК. С.NevmerzhitskayaK. S.

Кристина Сергеевна Невмержицкая – ассистент кафедры

Екатеринбург

Kristina S. Nevmerzhitskaya – department assistant

Ekaterinburg

nks16@list.ruhttps://orcid.org/0000-0002-2478-727XВолковаЛ. И.VolkovaL. I.

Лариса Ивановна Волкова – доктор медицинских наук, профессор

Екатеринбург

Larisa I. Volkova – Doctor of Medicine, Professor

Ekaterinburg

lar-volkova@mail.ruСергееваМ. В.SergeevaM. V.

Марина Викторовна Сергеева – научный сотрудник

Екатеринбург

Marina V. Sergeeva – research associate

Ekaterinburg

marin@ecko.uran.ruФГБОУ ВО «Уральский Государственный Медицинский Университет» Минздрава РоссииРоссияUral State Medical UniversityRussian FederationФГБУН «Институт промышленной экологии» УрО РАНРоссияInstitute of industrial Ecology UB RASRussian Federation2021230320222065762Copyright © Невмержицкая К.С., Волкова Л.И., Сергеева М.В., 20222022Невмержицкая К.С., Волкова Л.И., Сергеева М.В.Nevmerzhitskaya K.S., Volkova L.I., Sergeeva M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/910Введение

Введение. Прогнозирование рецидива при остром демиелинизирующем эпизоде (ОДЭ) у детей является актуальной проблемой, поскольку прогрессирующие демиелинизирующие заболевания ассоциированы с риском инвалидности и когнитивных нарушений.

Материалы и методы

Материалы и методы. Проведено описательное когортное исследование. Представлены результаты длительного наблюдения 75 детей после первого эпизода демиелинизации. На основании клинических и радиологических параметров дебюта методом логистической регрессии определены факторы прогноза рецидива демиелинизирующих заболеваний (ДЗ) у детей.

Результаты

Результаты. При сопоставлении клинико-инструментальных признаков дебюта демиелинизирующего заболевания факторы, ассоциированые с развитием рецидива неврологической дисфункции после первого эпизода демиелинизации. К ним были отнесены: возраст ≥ 11 лет (р=0,000), симптомокомплекс поражения ствола головного мозга (р=0,002), множественные очаги демиелинизации на магнитно-резонансной томографии головного мозга (р=0,001) с характерной локализацией в перивентрикулярных (р=0,002), субкортикальных областях (р=0,001), стволе мозга (р=0,006), очаги с четким контуром края (р=0,03) и расположенные перпендикулярно мозолистому телу (р=0,002), очаги в шейном отделе спинного мозга (р=0,02) и смещенные от центра спинного мозга (р=0,02). Регрессионный анализ показал независимые факторы риска рецидива при демиелинизирующих заболеваниях у детей: возраст ≥ 11 лет (ОШ=1,34, 95% ДИ (1,11:1,61), р=0,003), поражение ствола головного мозга (ОШ=7,00, 95%ДИ (0,73:67,25, р=0,09), многоочаговая картина поражения ЦНС, соответствовавшая критериями диссеминации очагов в пространстве McDonald (2010) (ОШ=8,60, 95% ДИ (2,24:33,07), р=0,002).

Обсуждение

Обсуждение. Существующие описания педиатрических популяций с демиелинизирующими заболеваниями зачастую имеют непродолжительный период наблюдения пациентов и сфокусированы на исходе в рассеянный склероз и нейрооптикомиелит. В статье представлены данные о факторах риска обострения после первого эпизода демиелинизации вне зависимости от нозологической принадлежности.

Заключение

Заключение. Установленные предикторы рецидива при ОДЭ у детей являются простыми и общедоступными для прогнозирования течения демиелинизирующих заболеваний.

Introduction

Introduction. Predicting relapse in acute demyelinating episode (ADE) in children is an urgent problem, since progressive demyelinating diseases are associated with the risk of disability and cognitive impairment.

Methods

Methods. Descriptive cohort study. The results of long-term follow-up of 75 children after the first episode of demyelination are presented. Based on the clinical and radiological parameters of the first demyelinating event, the prognostic factors for the relapse in children were determined using the logistic regression method.

Results

Results. When comparing the clinical and instrumental signs of the first demyelinating event, we identified those that were significantly associated with relapse. These included age ≥ 11 years (p <0.001), brain stem symptoms (p = 0.002), multiple demyelinating lesions on brain magnetic resonance imaging (p = 0.001) periventricular (p = 0.002), subcortical (p = 0.001), brainstem lesions (p = 0.006), well-defined lesions (p = 0.03) and perpendicular to the corpus callosum lesions (p = 0.002), cervical spinal cord lesions (p = 0, 02) and lateralized spinal cord lesions (p = 0.02). Regression analysis showed independent risk factors for relapse in children with demyelinating diseases: age ≥ 11 years (OR = 1.34, 95% CI (1.11: 1.61), p = 0.003), brain stem symptoms (OR = 7.00, 95% CI (0.73: 67.25, p = 0.09), multiple CNS lesions, corresponding to the criteria for dissemination by McDonald (2010) (OR = 8.60, 95% CI (2, 24: 33.07), p = 0.002).

Discussion

Discussion. Existing descriptions of pediatric populations with demyelinating diseases often have short follow-up and focus on outcomes in multiple sclerosis and neuromyelitis optica. The article presents data on previously unexplored risk factors for exacerbation after the first episode of demyelination. Conclusion. The identified predictors of relapse in ADE in children are a simple and generally available tool for predicting the course of demyelinating diseases.

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The authors declare that there are no conflicts of interest present.