Miller D H, Hornabrook R W, Purdie G
Department of Medicine, Wellington School of Medicine, University of Otago, Wellington Hospital, New Zealand.
J Neurol Neurosurg Psychiatry. 1992 May;55(5):341-6. doi: 10.1136/jnnp.55.5.341.
A regional survey of multiple sclerosis (MS) patients in Wellington, New Zealand in 1983 identified 245 patients, giving a prevalence (all categories included) of 72 per 100,000. Retrospective review of the history and medical records identified a poorer prognosis for disability where there was progressive onset of symptoms, secondary progression after a remitting phase, older age of onset (40 years or more), or a motor syndrome involving the limbs at presentation. In 1983 follow up data were obtained on 96 patients who were seen during a previous survey in 1968. For those with definite or probable MS, progression to severe disability (Kurtzke disability status scale (DSS) 6-9) or death (DSS 10) was seen in 26/34 with moderate disability (DSS 3-5) in 1968 and in only 5/29 with mild disability (DSS 0-2). When the analysis is confined to those with symptoms for at least five years in 1968, severe disability or death from MS occurred in 22/30 with moderate and 4/19 with mild disability (chi 2 = 10.8, p = 0.001). It is concluded that the patient's established disability level after five years of illness is a useful, but not infallible, prognostic indicator. From the follow up of the 1968 patients, the probability of MS-related mortality for a given disease duration was calculated. Using this survival distribution to adjust the disability ratings in the 1983 population, it was found that the proportion with mild disability decreased steadily with increasing disease duration, reaching 14% when the disease duration was more than 25 years.
1983年在新西兰惠灵顿对多发性硬化症（MS）患者进行的一项区域调查中，共识别出245例患者，患病率（包括所有类型）为每10万人中有72例。对病史和病历进行回顾性分析发现，症状呈渐进性发作、缓解期后出现继发进展、发病年龄较大（40岁及以上）或发病时出现累及四肢的运动综合征的患者，残疾预后较差。1983年，获取了96例在1968年之前的一次调查中见过的患者的随访数据。对于那些确诊或可能患有MS的患者，1968年时，34例中度残疾（Kurtzke残疾状态量表（DSS）3 - 5级）患者中有26例进展为严重残疾（DSS 6 - 9级）或死亡（DSS 10级），而29例轻度残疾（DSS 0 - 2级）患者中只有5例如此。当分析仅限于1968年出现症状至少5年的患者时，MS导致的严重残疾或死亡在30例中度残疾患者中有22例，19例轻度残疾患者中有4例（χ² = 10.8，p = 0.001）。得出的结论是，患病5年后患者已确定的残疾水平是一个有用但并非绝对可靠的预后指标。通过对1968年患者的随访，计算出了给定病程的MS相关死亡率。利用这种生存分布来调整1983年人群中的残疾评级，发现轻度残疾的比例随着病程延长而稳步下降，病程超过25年时降至14%。
