Pittock S J, Mayr W T, McClelland R L, Jorgensen N W, Weigand S D, Noseworthy J H, Weinshenker B G, Rodriguez M
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Neurology. 2004 Jan 13;62(1):51-9. doi: 10.1212/01.wnl.0000101724.93433.00.
S: To study the change in disability over 10 years in individual patients constituting the 1991 Olmsted County, MN, multiple sclerosis (MS) prevalence cohort.
The authors reassessed this 1991 cohort in 2001. The authors determined the Expanded Disability Status Scale scores (EDSS) for each patient still alive, and within the year prior to death for those who died. The authors analyzed determinants of potential prognostic significance on change in disability.
Follow-up information was available for 161 of 162 patients in the 1991 cohort. Only 15% had received immunomodulatory therapy. The mean change in EDSS for the entire cohort over 10 years was 1 point and 20% worsened by >or=2 points. For patients with EDSS <3 in 1991 (n = 66), 83% were ambulatory without a cane 10 years later. For patients with EDSS of 3 through 5 in 1991 (n = 33), 51% required a cane to ambulate (48%) or worse (3%). For patients with EDSS 6 to 7 in 1991 (n = 39), 51% required a wheelchair or worse in 2001. Gait impairment at onset, progressive disease, or longer duration of disease were associated with more worsening of disability (p < 0.002). The 10-year survival was decreased compared with the Minnesota white population for both men and women.
Although survival was reduced and 30% of patients progressed to needing a cane or wheelchair or worse over the 10-year follow-up period, most remained stable or minimally progressed. Patients within the EDSS 3.0 through 5.0 range are at moderate risk of developing important gait limitations over the 10-year period. The authors did not identify factors strongly predictive of worsening disability in this study.
研究构成1991年明尼苏达州奥尔姆斯特德县多发性硬化症（MS）患病率队列的个体患者10年间残疾状况的变化。
作者于2001年对该1991年队列进行了重新评估。作者确定了每位仍在世患者以及死亡患者在死亡前一年的扩展残疾状况量表（EDSS）评分。作者分析了对残疾变化具有潜在预后意义的决定因素。
1991年队列中的162名患者中有161名有随访信息。仅15%的患者接受过免疫调节治疗。整个队列10年间EDSS的平均变化为1分，20%的患者恶化≥2分。1991年EDSS<3的患者（n = 66），10年后83%无需手杖行走。1991年EDSS为3至5的患者（n = 33），51%需要手杖行走（48%）或状况更差（3%）。1991年EDSS为6至7的患者（n = 39），2001年51%需要轮椅或状况更差。发病时的步态障碍、疾病进展或病程较长与残疾状况恶化程度更高相关（p < 0.002）。男性和女性的10年生存率均低于明尼苏达州白人人群。
尽管在10年随访期内存活率降低，30%的患者病情进展至需要手杖、轮椅或状况更差，但大多数患者病情保持稳定或进展轻微。EDSS在3.0至5.0范围内的患者在10年期间出现重要步态限制的风险中等。作者在本研究中未发现能强烈预测残疾状况恶化的因素。
