Kaufman Michael D, Johnson Susan K, Moyer David, Bivens Jessica, Norton H James
Multiple Sclerosis Center, Carolinas Medical Center, Charlotte, North Carolina 28223, USA.
Am J Phys Med Rehabil. 2003 Aug;82(8):582-90. doi: 10.1097/01.PHM.0000078199.99484.E2.
Although epidemiology indicates that multiple sclerosis is more common among whites than African Americans, the course of disease may be more aggressive among African Americans. This study examines disease course in a large multiple sclerosis clinic population.
A case-controlled, retrospective record review compared the severity of multiple sclerosis for African Americans and for whites. Because the baseline demographics of the two groups differed, we performed analyses of multiple subgroups in an attempt to control for various characteristics.
Consistent evidence of more disability in African Americans compared with whites was found, although subgroups were often too small to establish statistical significance. African Americans had a higher mean Expanded Disability Status Scale score than whites in a subgroup selected to minimize differences in access to care and disease perceptions. African Americans reported limb weakness as a presenting symptom of multiple sclerosis more frequently than did whites. When patients were followed at our multiple sclerosis center, rates of disease progression were nearly identical.
More African Americans than whites experience pyramidal system involvement early in multiple sclerosis, leading to greater disability as measured by the ambulation-sensitive Expanded Disability Status Scale. Once patients have moderate difficulty walking, the rate of progression is the same for both groups, albeit occurring at a later age for whites than for African Americans.
尽管流行病学研究表明，白人中多发性硬化症的发病率高于非裔美国人，但非裔美国人的病程可能更为严重。本研究调查了一家大型多发性硬化症诊所中患者的病程情况。
采用病例对照、回顾性记录审查的方法，比较非裔美国人和白人多发性硬化症的严重程度。由于两组的基线人口统计学特征不同，我们对多个亚组进行了分析，以控制各种特征因素。
尽管亚组规模往往过小，无法得出具有统计学意义的结果，但仍发现了一致的证据，表明非裔美国人比白人存在更多残疾情况。在一个旨在尽量减少医疗服务可及性和疾病认知差异的亚组中，非裔美国人的扩展残疾状态量表（Expanded Disability Status Scale）平均得分高于白人。非裔美国人将肢体无力作为多发性硬化症首发症状的报告频率高于白人。在我们的多发性硬化症中心对患者进行随访时，两组的疾病进展速率几乎相同。
与白人相比，更多非裔美国人在多发性硬化症早期就出现锥体系统受累，导致在对行走敏感的扩展残疾状态量表测量下出现更严重的残疾。一旦患者行走出现中度困难，两组的疾病进展速率相同，尽管白人出现这种情况的年龄比非裔美国人晚。
