Debouverie M, Rumbach L, Clavelou P
Service de neurologie, Hôpital central, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
Rev Neurol (Paris). 2007 Jun;163(6-7):637-45. doi: 10.1016/s0035-3787(07)90472-5.
According to the available previous studies, France is considered a zone of medium to high risk of multiple sclerosis (MS) with an estimated overall prevalence of at least 50/100,000 inhabitants, incidence rates were stable in some areas but increased over time in others and a strong ethnic effect on the incidence, clinical presentation, and course of MS is reported.
Based on two health insurance survey the prevalence has been deduced. At January 1, 2003 from the data of agricultural health insurance the prevalence is evaluated at 65.5/100,000 inhabitants (95p.cent CI=62.5-67.5) with a gradient of North East towards South-West. The data from the national health insurance were very near. During the period 2000-2004, recent studies in Auvergne and Brittany demonstrated an annual incidence comprising between 4.2 and 5.1 per 100,000 inhabitants. In Lorraine, in a large population-based study, in December 31, 2004 the prevalence rate was 120/100,000 (95p.cent CI: 119 to 121). During the period 1990-2002, the average age- and sex-adjusted annual incidence rate was 5.5/100,000 (95p.cent CI: 4.4-6.6). In Lorraine, we found that the age-adjusted incidence rate increased during the period 1990-2002. The incidence of MS in women increased, whereas that in men did not change significantly during this period. Similarly, in Norway, North Ireland and Denmark, the incidence among women increased the most. The clinical features of MS were compared in 211 North Africans patients and 2 945 Europeans patients in two French MS centres (Lorraine and Nice) with definite MS according to McDonald's criteria. The course of MS appears more aggressive in North Africans than in Europeans patients. For example, we demonstrated a shorter time to reach the Expanded Disability Status Scale score of 4.0 (p=0.001) or 6.0 (p<0.0001) in North Africans patients.
The incidence rates found in these studies were comparable to those reported in several European populations. This undoubtedly places France in the category of regions with a high risk zone of MS. The incidence of MS in women increased; thus, exogenous (or epigenetic) factors vary over time and may affect men and women differently. The course of MS appears more aggressive in North Africans than in Europeans patients.
根据以往现有研究，法国被视为多发性硬化症（MS）中高风险地区，估计总体患病率至少为每10万居民50例，某些地区发病率稳定，但其他地区随时间有所上升，并且有报道称种族对MS的发病率、临床表现及病程有显著影响。
基于两项医疗保险调查推断出患病率。根据农业医疗保险数据，2003年1月1日的患病率评估为每10万居民65.5例（95%置信区间=62.5 - 67.5），呈现出从东北向西南递减的梯度。国家医疗保险数据与之相近。在2000 - 2004年期间，奥弗涅和布列塔尼的近期研究表明年发病率为每10万居民4.2至5.1例。在洛林，一项基于大量人群的研究显示，2004年12月31日的患病率为120/10万（95%置信区间：119至121）。在1990 - 2002年期间，经年龄和性别调整后的年平均发病率为5.5/10万（95%置信区间：4.4 - 6.6）。在洛林，我们发现1990 - 2002年期间年龄调整后的发病率有所上升。在此期间，女性MS发病率上升，而男性发病率无显著变化。同样，在挪威、北爱尔兰和丹麦，女性发病率上升最为明显。在法国的两个MS中心（洛林和尼斯），根据麦克唐纳标准确诊为MS的211名北非患者和2945名欧洲患者的MS临床特征进行了比较。MS病程在北非患者中似乎比欧洲患者更具侵袭性。例如，我们发现北非患者达到扩展残疾状态量表评分4.0（p = 0.001）或6.0（p < 0.0001）的时间更短。
这些研究中发现的发病率与欧洲其他一些人群的报道相当。这无疑使法国属于MS高风险地区类别。女性MS发病率上升；因此，外源性（或表观遗传）因素随时间变化，可能对男性和女性产生不同影响。MS病程在北非患者中似乎比欧洲患者更具侵袭性。
