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首页> 外文期刊>The Internet Journal of Neurology >Pathogenesis and treatment of multiple sclerosis (MS)
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Pathogenesis and treatment of multiple sclerosis (MS)

机译：多发性硬化症（MS）的发病机制和治疗

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Multiple sclerosis is a chronic inflammatory disease of the nervous system in which a T-cell-mediated inflammatory process is associated with destruction of myelin sheaths. In present review, the main clinical aspects and the basic features of the MS (Multiple sclerosis) with diagnosis, including the new McDonald criteria and the treatment approach to MS are discussed. The pathophysiology of multiple sclerosis is reviewed, with emphasis on the axonal conduction properties underlying the production of symptoms and the course of the disease. Various demyelination patterns and their correlation with the disease types have been discussed. Finally, a brief description of the available treatments is discussed. In addition to this, newer targets for the treatment of MS are also reviewed. Introduction Multiple sclerosis (MS) is a chronic, potentially debilitating disease that affects central nervous system, which is made up of brain and spinal cord. Multiple sclerosis is widely believed to be an autoimmune disease, a condition in which immune system attacks components of body. In multiple sclerosis, the body mistakenly directs antibodies and white blood cells against proteins in the myelin sheath, a fatty substance that insulates nerve fibers in brain and spinal cord. This results in inflammation and injury to the sheath and ultimately to the nerves that it surrounds. The result may be multiple areas of scarring (sclerosis). Eventually, this damage can slow or block the nerve signals that control muscle coordination, strength, sensation and vision. Epidemiology MS is the one of the leading causes of neurological disability in young adults, second only to traumatic accidents 1 . Certain factors are highly correlated with the risk of developing MS. The disease is usually diagnosed in patients between ages 20 and 45 years 1,2,3,4 . Only 5% of people diagnosed with MS are younger than 10 or older than 50 4 . More women are afflicted than men, at a ratio of 2:1. Yet, men are usually diagnosed at a later age and are more likely to develop the progressive form of the disease. In addition, people who live farther away from the equator are more at risk. Ethnic differences in prevalence also exist: MS more frequently affects whites of Scandinavian ancestry than other ethnic groups 2 . MS occurs in relatives of patients more often than in the general population. Multiple sclerosis affects an estimated 300,000 patients in the United States (US) and probably more than 1 million patients around the world — including twice as many women as men. Most patients experience their first signs or symptoms between ages 20 and 40.Multiple sclerosis is unpredictable and varies in severity. In some patients, multiple sclerosis is a mild illness, but it can lead to permanent disability in others. Treatments can modify the course of the disease and relieve symptoms. Etiology The exact causes of MS are not known. Most experts agree that MS is probably caused from an altered immune system, an environmental exposure (i.e., infectious agent), or both. Evidence showing that the immune system has a major role in the pathogenesis of MS is overwhelming 4,5 . Based on this theory, MS results from an autoimmune attack against self-myelin or self-oligodendrocyte antigens by macrophages, killer T cells, lymphokines and/or antibodies when they cross into the brain 2 .Other research suggests that environmental exposures may promote MS, possibly due to one or more viruses 6 . These viruses include measles, mumps, rubella, varicella and Epstein-Barr and may be involved in the pathogenesis of MS in several ways 7 .(1) Transient or persistent infection outside the central nervous system (CNS) may activate autoreactive T cells. (2) Alternatively, transient CNS infection may initiate a cascade of events that fosters autoimmunity. (3) Recurrent CNS infections may precipitate repeated inflammation and demyelination, or (4) persistent CNS viral infection may incite inflammatory reacti
机译：多发性硬化症是神经系统的慢性炎性疾病，其中T细胞介导的炎性过程与髓鞘的破坏有关。在本综述中，讨论了具有诊断的MS（多发性硬化症）的主要临床方面和基本特征，包括新的McDonald标准和MS的治疗方法。多发性硬化症的病理生理学进行了审查，重点是症状的产生和疾病过程的轴突传导特性。讨论了各种脱髓鞘模式及其与疾病类型的相关性。最后，讨论了可用治疗的简要说明。除此之外，还审查了用于治疗MS的新靶标。简介多发性硬化症（MS）是一种慢性的，可能使人衰弱的疾病，会影响由大脑和脊髓组成的中枢神经系统。人们普遍认为多发性硬化症是一种自身免疫性疾病，免疫系统会攻击身体的各个部分。在多发性硬化症中，人体错误地针对髓鞘中的蛋白质错误地引导抗体和白细胞，髓鞘是一种脂肪物质，可使大脑和脊髓的神经纤维绝缘。这会导致发炎和对护套的伤害，并最终伤害到其周围的神经。结果可能是多个区域的疤痕（硬化）。最终，这种损伤会减慢或阻塞控制肌肉协调，力量，感觉和视力的神经信号。流行病学MS是年轻人神经系统残疾的主要原因之一，仅次于创伤事故1。某些因素与患MS的风险高度相关。通常在20至45岁1,2,3,4岁的患者中诊断出该病。诊断为MS的人中，只有5％的年龄小于10岁或大于50 4。妇女受苦的人数比男人多，比率为2：1。然而，男性通常被诊断出年龄较高，并且更有可能发展为疾病的进展形式。此外，居住在离赤道较远的人们面临更大的危险。在患病率方面也存在种族差异：与其他种族相比，MS对斯堪的纳维亚血统的白人影响更大。2 MS患者的亲属比普通人群更常见。在美国，多发性硬化症影响了300,000名患者，全球可能影响着超过100万名患者，其中女性是男性的两倍。大多数患者在20至40岁之间经历其最初的体征或症状。在某些患者中，多发性硬化症是一种轻度疾病，但在其他患者中则可能导致永久性残疾。治疗可以改变病程并缓解症状。病因尚不清楚MS的确切原因。大多数专家都认为MS可能是由于免疫系统改变，环境暴露（即传染原）或两者兼而有之。有证据表明，免疫系统在MS的发病机理中起着重要作用，这是令人难以置信的4,5。根据这一理论，MS是由巨噬细胞，杀伤性T细胞，淋巴因子和/或抗体进入大脑后对自身髓磷脂或自身少突胶质细胞抗原的自身免疫攻击而引起的2。其他研究表明，环境暴露可能会促进MS，可能是由于一种或多种病毒6。这些病毒包括麻疹，腮腺炎，风疹，水痘和爱泼斯坦-巴尔，并且可能以几种方式参与MS的发病机制。7。（1）中枢神经系统（CNS）以外的暂时性或持续性感染可能会激活自身反应性T细胞。 （2）另外，短暂的中枢神经系统感染可引发一系列促进自身免疫的事件。 （3）复发性中枢神经系统感染可能导致反复发炎和脱髓鞘，或（4）持续性中枢神经系统病毒感染可能引起炎症反应

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