National MS Center Melsbroek, Vanheylenstraat 16, 1820, Melsbroek, Belgium.
J Neurol. 2012 May;259(5):855-61. doi: 10.1007/s00415-011-6267-7. Epub 2011 Oct 13.
Female gender and hormones have been associated with disease activity in multiple sclerosis (MS). We investigated age at menarche, use of oral contraceptives and pregnancy in relation to progression of disability in relapsing onset and progressive onset MS. We conducted a cross-sectional survey among individuals with MS, registered by the Flemish MS Society in Belgium. A time-to-event analysis and Cox proportional hazard regression were performed with time to Expanded Disability Status Score (EDSS) of 6 (requires a cane) as outcome measure. Hazard ratios for the time from onset and the time from birth were adjusted for age at onset and immunomodulatory treatment. Data on 973 women with definite MS were collected. In the relapsing onset group, women with at least two pregnancies had a reduced risk to reach EDSS 6 compared with nulliparous women. In the progressive onset group, later age at menarche was associated with a reduced risk to reach EDSS 6, whereas oral contraceptive use was associated with a higher risk of reaching EDSS 6. Our study corroborates the association of pregnancies with a reduced progression of disability in relapsing onset MS. In progressive onset MS, a slower progression was found in women with a later onset of menarche and a more rapid progression occurred when women reported the use of oral contraceptives.
女性性别和激素与多发性硬化症 (MS) 的疾病活动有关。我们研究了初潮年龄、口服避孕药和妊娠与复发型和进展型 MS 残疾进展的关系。我们对在比利时佛兰芒多发性硬化症协会登记的 MS 患者进行了横断面调查。使用扩展残疾状态评分 (EDSS) 达到 6（需要拐杖）的时间作为结局指标，进行了时间事件分析和 Cox 比例风险回归。从发病开始和从出生开始的时间的风险比根据发病年龄和免疫调节治疗进行了调整。收集了 973 名明确的 MS 女性的数据。在复发型组中，与未生育的女性相比，至少有两次妊娠的女性达到 EDSS 6 的风险降低。在进展型组中，初潮年龄较晚与达到 EDSS 6 的风险降低相关，而口服避孕药的使用与达到 EDSS 6 的风险增加相关。我们的研究证实了妊娠与复发型 MS 残疾进展减少之间的关联。在进展型 MS 中，初潮较晚的女性进展较慢，而报告使用口服避孕药的女性进展较快。
