University Lecturer, Eulerweg 4, D-64347 Griesheim, Germany.
Expert Rev Neurother. 2010 Mar;10(3):421-40. doi: 10.1586/ern.10.7.
The etiology of multiple sclerosis is, at present, not definitely known, but genetic and environmental factors play a role in its causation. Environmental causes have a predominant impact. Epidemiologic research has contributed considerably to the identification of external risk factors in this multifactorial setting, but methodological constraints still play a major part. Viral and other microbial agents have drawn much attention, although none of them is a necessary condition for the disease. This is true also for the Epstein-Barr virus, for which most data, including prospective data, supports a role in the majority of multiple sclerosis patients. In parallel, the hypothesis is still attractive in that it is not the virus per se, but rather more the age when it infects the human being that is the crucial matter. Other risk factors, such as tobacco smoking and vitamin D deficiency, which have immunomodulating properties, may also play some role, although the latter is not compatible with all data of the descriptive epidmiology of multiple sclerosis. Diet might be of considerable importance, all the more since multiple sclerosis can be ecologically attributed to a certain food patterns and is inversely associated with others (e.g., the 'Mediterranean diet'). The hypothesis that the preservation of meat by nitrite and wood smoke plays a role, and the protective influence of a fish and, possibly, a vegetable diet, are supported by some studies, but methodological constraints limit, at present, definite conclusions. A new avenue is the search for an interaction between genetic and environmental causes, and also between several environmental factors that might lead to new approaches for prevention and, perhaps, for the treatment of multiple sclerosis.
多发性硬化症的病因目前尚不清楚，但遗传和环境因素在其发病机制中起作用。环境因素起主要作用。流行病学研究在确定这种多因素环境中的外部危险因素方面做出了相当大的贡献，但方法学上的限制仍然起着重要作用。病毒和其他微生物因素引起了广泛关注，尽管它们都不是疾病的必要条件。爱泼斯坦-巴尔病毒也是如此，包括前瞻性数据在内的大多数数据都支持其在大多数多发性硬化症患者中的作用。与此同时，这一假说仍然具有吸引力，因为起作用的不是病毒本身，而是人感染病毒的年龄。其他危险因素，如具有免疫调节特性的吸烟和维生素 D 缺乏，也可能起一定作用，尽管后者与多发性硬化症描述性流行病学的所有数据并不兼容。饮食可能非常重要，尤其是因为多发性硬化症可以从生态学上归因于某些食物模式，而与其他食物模式相反（例如“地中海饮食”）。一些研究支持这样的假设，即亚硝酸盐和木烟保存肉类以及鱼类（可能还有蔬菜）饮食的保护作用，但方法学上的限制目前限制了明确的结论。一个新的途径是寻找遗传和环境因素之间以及几个环境因素之间的相互作用，这些因素可能为预防和治疗多发性硬化症提供新的方法。
