Department of Medicine, Division of Neurology, University of British Columbia, , Vancouver, British Columbia, Canada.
J Neurol Neurosurg Psychiatry. 2013 Nov;84(11):1192-8. doi: 10.1136/jnnp-2013-304951. Epub 2013 Jun 6.
To explore the occurrence and characteristics of aggressive multiple sclerosis (AMS) in adult-onset multiple sclerosis (MS) patients.
Prospectively collected data (1980-2009) from British Columbia, Canada, were retrospectively analysed. AMS was defined in three different ways (AMS1, 2 and 3): 'AMS1'--confirmed Expanded Disability Status Scale (EDSS) ≥ 6 within 5 years of MS onset; 'AMS2'--confirmed EDSS ≥ 6 by age 40; and 'AMS3'--secondary progressive MS within 3 years of a relapsing-onset course. Three respective 'non-aggressive' MS comparison cohorts were selected. Patients' characteristics were compared between aggressive and non-aggressive cohorts using multivariable logistic regression, with findings expressed as adjusted OR (AOR) and 95% CI.
Application of the three definitions to the source population of 5891 patients resulted in 235/4285 (5.5%) patients fulfilling criteria for AMS1 (59.6% were female; 74.5% had relapsing-onset MS), 388/2762 (14.0%) for AMS2 (65.2% were female; 92.8% had relapsing-onset MS) and 195/4918 (4.0%) patients for AMS3 (61.0% were female). Compared to the respective control cohorts, those with AMS were more likely to be male (AOR=1.5, 95% CI 1.1 to 2.0 (AMS1); 1.6, 95% CI 1.3 to 2.1 (AMS2); 1.8, 95% CI 1.3 to 2.4 (AMS3)), older at MS symptom onset (AOR=1.1; 95% CI 1.1 to 1.1 (AMS1 and AMS3)) and have primary progressive MS (AOR=2.3, 95% CI 1.6 to 3.3 (AMS1); 2.7, 95% CI 1.7 to 4.4 (AMS2)).
AMS was identified in 4-14% of patients, depending on the definition used. Although there was a relative preponderance of men and primary progressive MS presenting with AMS, the majority of patients were still women and those with relapsing-onset MS.
探讨成人发病多发性硬化症（MS）患者中侵袭性多发性硬化症（AMS）的发生和特征。
回顾性分析了 1980 年至 2009 年期间在加拿大不列颠哥伦比亚省前瞻性收集的数据。采用三种不同的方法定义 AMS（AMS1、2 和 3）：“AMS1”-在 MS 发病后 5 年内确诊扩展残疾状况量表（EDSS）≥6；“AMS2”-40 岁前确诊 EDSS≥6；“AMS3”-在复发性发作病程后 3 年内发展为继发性进行性 MS。选择了三个相应的“非侵袭性”MS 比较队列。使用多变量逻辑回归比较侵袭性和非侵袭性队列之间的患者特征，结果表示为调整后的 OR（AOR）和 95%置信区间。
在 5891 例患者的原始人群中应用三种定义，有 235/4285（5.5%）例患者符合 AMS1 标准（59.6%为女性；74.5%为复发性 MS），388/2762（14.0%）例患者符合 AMS2 标准（65.2%为女性；92.8%为复发性 MS），195/4918（4.0%）例患者符合 AMS3 标准（61.0%为女性）。与各自的对照队列相比，患有 AMS 的患者更有可能为男性（AOR=1.5，95%CI 1.1 至 2.0（AMS1）；1.6，95%CI 1.3 至 2.1（AMS2）；1.8，95%CI 1.3 至 2.4（AMS3）），发病年龄较大（AOR=1.1；95%CI 1.1 至 1.1（AMS1 和 AMS3）），原发性进展性 MS（AOR=2.3，95%CI 1.6 至 3.3（AMS1）；2.7，95%CI 1.7 至 4.4（AMS2））。
根据所使用的定义，在 4-14%的患者中发现了 AMS。尽管男性和原发性进展性 MS 患者中 AMS 的发病率相对较高，但大多数患者仍是女性，且为复发性 MS 患者。
