Chancellor A M, Warlow C P
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
J Neurol Neurosurg Psychiatry. 1992 Dec;55(12):1106-15. doi: 10.1136/jnnp.55.12.1106.
This review examines the commonly held premise that, apart from the Western Pacific forms, motor neuron disease (MND), has a uniform worldwide distribution in space and time; the methodological problems in studies of MND incidence; and directions for future epidemiological research. MND is more common in men at all ages. Age-specific incidence rises steeply into the seventh decade but the incidence in the very elderly is uncertain. A rise in mortality from MND over recent decades has been demonstrated wherever this has been examined and may be real rather than due to improved case ascertainment. Comparison of incidence studies in different places is complicated by non-standardised methods of case ascertainment and diagnosis but there appear to be differences between well studied populations. In developed countries in the northern hemisphere there is a weak positive correlation between standardised, age-specific incidence and distance from the equator. There is now strong evidence for an environmental factor as the cause of the Western Pacific forms of MND. A number of clusters of sporadic MND have been reported from developed countries, but no single agent identified as responsible.
本综述探讨了一个普遍的前提，即除西太平洋地区的类型外，运动神经元病（MND）在全球范围内在空间和时间上具有统一的分布；MND发病率研究中的方法学问题；以及未来流行病学研究的方向。MND在各年龄段男性中更为常见。特定年龄的发病率在七十多岁时急剧上升，但极高龄人群的发病率尚不确定。近几十年来，无论在何处进行研究，都已证明MND的死亡率有所上升，这可能是实际情况，而非病例确诊改善所致。不同地区发病率研究的比较因病例确诊和诊断方法不规范而变得复杂，但在研究充分的人群之间似乎存在差异。在北半球的发达国家，标准化的特定年龄发病率与距赤道的距离之间存在微弱的正相关。现在有强有力的证据表明，环境因素是西太平洋地区MND类型的病因。发达国家报告了一些散发性MND病例聚集的情况，但尚未确定单一的致病因素。
