OBJECTIVES:To analyze all the arguments against chronic cerebrospinal venous insufficiency (CCSVI) as a medical entity, and its association with multiple sclerosis (MS) and to revise all the findings suggesting a possible connection between these two entities. METHODS:We revised the methodology and results of all fourteen published studies on prevalence of CCSVI in MS patients. Furthermore, we take into consideration other work dealing with possible causes and explanations of venous, as well as vascular dysfunctions linked with MS. RESULTS:Studies of prevalence show a great variability in prevalence of CCSVI in MS patients. However, a recent meta-analysis assessed an over 13 times increased prevalence in MS. Global hypoperfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Post-mortem studies show a higher prevalence of intraluminal defects in the main extracranial vein in MS patients in respect to controls. DISCUSSION:Taking into account the current epidemiological data, the autoptic findings, and the relationship between CCSVI and both hypoperfusion and cerebrospinal fluid flow, CCSVI can be inserted in the list of multiple factors involved in MS pathogenesis. Our careful data analysis may conclude that great variability in prevalence of CCSVI in MS patients can be a result of different methodologies used in venous ultrasound assessment. Finally, it has been proven that CCSVI share the three main risk factors with MS. On the other hand, smoking is the most important risk factor for endothelial cell damage, vitamin D has a protective role and Epstein-Barr virus passes the blood-brain barrier by invading the endothelial cells, therefore, epidemiologically, linking the imbalance of these three factors to MS through autoimmunity.

译文

目的:分析所有反对慢性脑脊髓静脉功能不全(CCSVI)作为医学实体的论点,及其与多发性硬化症(MS)的关联,并修订所有发现,暗示这两个实体之间可能存在联系。
方法:我们修订了所有十四项有关MS患者CCSVI患病率的已发表研究的方法和结果。此外,我们考虑了其他有关可能的原因和解释,以及与MS相关的血管功能障碍的解释的工作。
结果:患病率研究显示,MS患者的CCSVI患病率存在​​很大差异。但是,最近的一项荟萃​​分析估计,MS患病率增加了13倍以上。研究表明,脑部整体灌注不足和MS中脑脊髓液动力学的降低与CCSVI有关。验尸研究表明,与对照组相比,MS患者颅内主要静脉腔内缺陷的患病率更高。
讨论:考虑到当前的流行病学数据,尸检结果以及CCSVI与灌注不足和脑脊髓液流量的关系,可以将CCSVI插入与MS发病机制有关的多种因素中。我们仔细的数据分析可能会得出结论,MS患者CCSVI患病率的巨大差异可能是静脉超声评估中使用不同方法的结果。最后,已证明CCSVI与MS共同承担了三个主要风险因素。另一方面,吸烟是内皮细胞受损的最重要危险因素,维生素D具有保护作用,爱泼斯坦-巴尔病毒通过侵入内皮细胞而通过血脑屏障,因此在流行病学上将这三个因素的失衡联系在一起自身免疫是影响MS的因素。

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