Karakteristike venske drenaže centralnog nervnog sistema kod obolelih od multiple skleroze

Abstract

Uvod: O hipotezi da je nedovoljna venska drenaža centralnog nervnog sistema (CNS) povezana sa multiplom sklerozom (MS) u naučnoj javnosti postoje kontradiktorni stavovi. Cilj: Glavni cilj rada bio je da se utvrdi da li postoji razlika u prisustvu stanja i znakova nedovoljne venske drenaže CNS kod obolelih od multiple skleroze u odnosu na grupu zdravih ispitanika i da li je nedovoljna venska drenaža CNS u grupi obolelih povezana sa određenom formom bolesti, odnosno da li utiče na stepen funkcionalne onesposobljenosti i brzinu progresije bolesti. Metod: U kliničku opservacionu studiju uključeno je 157 obolelih od MS koji nisu dobijali terapiju koja modifikuje prirodni tok bolesti i 56 zdravih ispitanika koji su činili kontrolnu grupu. Kod svih ispitanika urađen je ultrazvučni pregled krvnih sudova vrata i dubokih vena mozga, po definisanom protokolu, da bi se utvrdilo eventualno prisustvo nedovoljne venske drenaže CNS definisane postojanjem (nezavisne varijable): • hronične cerebrospinalne venske insuficijencije (HCSVI); • i/ili segmentne stenoze vene jugularis interne (VJI); • i/ili refluksa u VJI pri Valsalvinom manevru. U grupi obolelih su određivane (zavisne varijable): • forma bolesti (klinički izolovan sindrom-KIS, relapsno remitentna - RR, sekundarno progresivna - SP); • funkcionalna onesposobljenost utvrđena pomoću EDSS ("Expanded Disability Status Scale"-EDSS ); • brzina progresije bolesti određena na osnovu MSSS ( "Multiple Sclerosis Severity Score"– MSSS) i vremena koje je proteklo do dostizanja vrednosti 6 na EDSS.

Introduction: There are a lot of contradictory data about the hypothesis that insufficient venous drainage of central nervous system (CNS) could lead to multiple sclerosis (MS). Aim: The main goal of this study was to determine if there is a difference in signs and symptoms of insufficient venous drainage of CNS in patients with MS in comparison to the group of healthy participants. Also, to determine if there is an association of insufficient venous drainage of the CNS with clinical course of MS, grade of functional disability and disease progression. Methodology: In this clinical observational study 157 patients with MS, without disease modifying therapy, and 56 healthy participants were included. The ulstasonographic examination of the neck blood vessels and deep brain veins was performed according to strictly defined protocol, to investigate the potential presence of insufficient vein drainage of the CNS. Insufficient vein drainage of the CNS was defined by presence of: • chronic cerebrospinal vein insuficiency (CCSVI) • and/or segmental stenosis of internal jugular vein (IJV) • and/or reflux in IJV during Valsava maneuver In the patient group we determined: • course of the disease (clinically isolated syndrome-CIS, relapse remitting-RR, secondary progressive-SP form of MS) • functional disability determined by EDSS ("Expanded Disability Status Scale") • disease progression determined by MSSS ("Multiple Sclerosis Severity Score") and by time up to EDSS≥ 6