Kihira Tameko, Kanno Seizi, Miwa Hideto, Okamoto Kazushi, Kondo Tomoyoshi
Department of Neurology, Wakayama Medical University, Wakayama City, Japan.
Amyotroph Lateral Scler. 2007 Jun;8(3):150-6. doi: 10.1080/17482960601179407.
The incidence of ALS in Wakayama Prefecture has been markedly higher than that elsewhere in the world. Recently, however, the incidence has gradually decreased, especially in men, and the age at onset has shifted to the elderly, indicating the possible role of exogenous factors in the development of ALS. To evaluate factors related to the disease, we conducted a retrospective study. This study examined 108 patients with definite ALS diagnosed according to El Escorial criteria and 302 neurological controls (older than 40 years old) consecutively admitted to Wakayama Medical Hospital between 1999 and 2004. Having past history of cervical spondylosis or spinal spondylotic myelopathy (CS/SSM) with/without surgical treatment, cervical MRI findings, history of bone fracture, and occupation at onset were compared between the ALS patients and the neurological controls. Among 108 ALS patients, 45.4% had past history of CS/SSM compared to 19.4% of the neurological controls (p<0.0001, OR: 3.725, 95% CI 2.173-6.387). Among the ALS patients, 13% had had surgical treatment for CS/SSM, which was significantly higher than the 4.3% of the neurological controls (p<0.003, OR: 4.333, 95% CI 1.647-11.401). Cervical MRI findings were classified into four grades according to the severity of canal narrowing and compression of the spinal cord. Regarding cervical MRI findings, the percentage of ALS patients who showed canal narrowing and compression of the spinal cord was significantly higher than that of the controls (ALS: 72.0%, the controls: 29.5%, OR: 4.799, 95% CI 2.65-8.70). Comparison of the occupation at disease onset revealed that primary and secondary industrial occupations significantly increased the risk of ALS (2.69, 95% CI 1.40-5.16, 2.81, 95% CI 1.45-5.46, respectively). Conversely, tertiary industrial occupations significantly decreased the risk of ALS (age- and sex-adjusted OR: 0.54, 95% CI 0.30-0.98). In conclusion, CS/SSM, surgical treatment for CS/SSM and occupation at onset are suspected to be risk factors for developing/triggering or worsening ALS.
和歌山县肌萎缩侧索硬化症（ALS）的发病率明显高于世界其他地区。然而，最近发病率逐渐下降，尤其是男性，发病年龄已转向老年人，这表明外源性因素在ALS发病过程中可能发挥了作用。为了评估与该疾病相关的因素，我们进行了一项回顾性研究。本研究调查了1999年至2004年间连续入住和歌山医科大学医院的108例根据埃尔埃斯科里亚尔标准确诊的确诊ALS患者和302例神经科对照（年龄超过40岁）。比较了ALS患者和神经科对照之间是否有颈椎病或脊髓型颈椎病（CS/SSM）病史（无论是否接受手术治疗）、颈椎MRI检查结果、骨折史以及发病时的职业。在108例ALS患者中，45.4%有CS/SSM病史，而神经科对照中有19.4%有该病史（p<0.0001，OR：3.725，95%CI 2.173-6.387）。在ALS患者中，13%因CS/SSM接受了手术治疗，这显著高于神经科对照中的4.3%（p<0.003，OR：4.333，95%CI 1.647-11.401）。根据椎管狭窄和脊髓受压的严重程度，将颈椎MRI检查结果分为四个等级。关于颈椎MRI检查结果，显示椎管狭窄和脊髓受压的ALS患者百分比显著高于对照组（ALS：72.0%，对照组：29.5%，OR：4.799，95%CI 2.65-8.70）。对发病时职业的比较显示，第一产业和第二产业职业显著增加了患ALS的风险（分别为2.69，95%CI 1.40-5.16；2.81，95%CI 1.45-5.46）。相反，第三产业职业显著降低了患ALS的风险（年龄和性别调整后的OR：0.54，95%CI 0.30-0.98）。总之，CS/SSM、CS/SSM的手术治疗以及发病时的职业被怀疑是ALS发生/触发或恶化的危险因素。
