Kasarskis Edward J, Lindquist Jennifer H, Coffman Cynthia J, Grambow Steven C, Feussner John R, Allen Kelli D, Oddone Eugene Z, Kamins Kimberly A, Horner Ronnie D
Lexington VA Medical Center, Lexington, Kentucky, USA.
Amyotroph Lateral Scler. 2009 Feb;10(1):35-41. doi: 10.1080/17482960802351029.
The increased incidence of ALS in military veterans of the first Persian Gulf War raised speculation that they may have a 'Persian Gulf' variant of ALS with atypical clinical features. Medical records of military veterans with ALS, previously identified in our epidemiological study, were evaluated for clinical features (age and site of onset, race, unexplained atypical findings) and ventilator-free survival. Comparisons between deployed versus non-deployed cohorts were made with deployment status based on designation by the Department of Defense Manpower Data Center (DMDC) or by self-report. Other than the young age of onset in both cohorts (40.8 years overall mean; 40.1 years for DMDC deployed, 41.2 years for DMDC non-deployed), review of the medical records failed to document any atypical features. After adjusting for bulbar onset, median survival from symptom onset in those > or =40 years of age was 35.5 months (2.96 years) compared to 64.7 months (5.39 years) in the group <40 years of age (hazard ratio (HR)=0.47, 95% CI 0.30-0.73, p=0.0006). After adjusting for age, median survival was 45.4 months (3.78 years) and 54.8 months (4.57 years) in bulbar- versus non-bulbar onset groups, respectively (HR=1.41, 95% CI 0.83-2.39, p=0.20). After adjusting for age and site of onset, deployed veterans had significantly shorter survival than non-deployed (40.2 vs. 57.0 months, HR=0.62, 95% CI 0.40-0.96, p=0.03) using DMDC data. In conclusion, although veterans developing ALS after deployment to the Persian Gulf in 1990-1991 exhibited otherwise typical clinical features, they experienced shorter ventilator-free survival than non-deployed veterans.
第一次海湾战争退伍军人中肌萎缩侧索硬化症（ALS）发病率的增加引发了一种推测，即他们可能患有具有非典型临床特征的“海湾地区”型ALS。对我们流行病学研究中先前确定的患有ALS的退伍军人的医疗记录进行了临床特征（发病年龄和部位、种族、不明原因的非典型发现）和无呼吸机生存期的评估。根据美国国防部人力数据中心（DMDC）的指定或自我报告的部署状态，对部署队列与未部署队列进行了比较。除了两个队列的发病年龄都较小（总体平均年龄40.8岁；DMDC部署组为40.1岁，DMDC未部署组为41.2岁）外，对医疗记录的审查未发现任何非典型特征。在调整延髓发病因素后，40岁及以上患者从症状出现起的中位生存期为35.5个月（2.96年），而40岁以下组为64.7个月（5.39年）（风险比（HR）=0.47，95%置信区间0.30 - 0.73，p = 0.0006）。在调整年龄因素后，延髓发病组和非延髓发病组的中位生存期分别为45.4个月（3.78年）和54.8个月（4.57年）（HR = 1.41，95%置信区间0.83 - 2.39，p = 0.20）。在调整年龄和发病部位因素后，使用DMDC数据显示，部署退伍军人的生存期明显短于未部署退伍军人（40.2个月对57.0个月，HR = 0.62，95%置信区间0.40 - 0.96，p = 0.03）。总之，尽管1990 - 1991年部署到海湾地区后患上ALS的退伍军人表现出典型的临床特征，但他们的无呼吸机生存期比未部署的退伍军人短。
