1 Department of Medicine, University of Melbourne, Melbourne, Australia.
Brain. 2013 Dec;136(Pt 12):3609-17. doi: 10.1093/brain/awt281. Epub 2013 Oct 18.
The aim of this work was to evaluate sex differences in the incidence of multiple sclerosis relapses; assess the relationship between sex and primary progressive disease course; and compare effects of age and disease duration on relapse incidence. Annualized relapse rates were calculated using the MSBase registry. Patients with incomplete data or <1 year of follow-up were excluded. Patients with primary progressive multiple sclerosis were only included in the sex ratio analysis. Relapse incidences over 40 years of multiple sclerosis or 70 years of age were compared between females and males with Andersen-Gill and Tweedie models. Female-to-male ratios stratified by annual relapse count were evaluated across disease duration and patient age and compared between relapse-onset and primary progressive multiple sclerosis. The study cohort consisted of 11 570 eligible patients with relapse-onset and 881 patients with primary progressive multiple sclerosis. Among the relapse-onset patients (82 552 patient-years), 48,362 relapses were recorded. Relapse frequency was 17.7% higher in females compared with males. Within the initial 5 years, the female-to-male ratio increased from 2.3:1 to 3.3:1 in patients with 0 versus ≥4 relapses per year, respectively. The magnitude of this sex effect increased at longer disease duration and older age (P < 10(-12)). However, the female-to-male ratio in patients with relapse-onset multiple sclerosis and zero relapses in any given year was double that of the patients with primary progressive multiple sclerosis. Patient age was a more important determinant of decline in relapse incidence than disease duration (P < 10(-12)). Females are predisposed to higher relapse activity than males. However, this difference does not explain the markedly lower female-to-male sex ratio in primary progressive multiple sclerosis. Decline in relapse activity over time is more closely related to patient age than disease duration.
这项工作的目的是评估多发性硬化症复发的性别差异；评估性别与原发性进行性疾病过程的关系；并比较年龄和疾病持续时间对复发发生率的影响。使用 MSBase 登记处计算了每年的复发率。排除数据不完整或随访时间<1 年的患者。只有原发性进行性多发性硬化症患者才被纳入性别比例分析。使用 Andersen-Gill 和 Tweedie 模型比较了女性和男性多发性硬化症 40 年或 70 岁以上的复发发生率。评估了疾病持续时间和患者年龄分层的每年复发计数的女性与男性的比例，并比较了复发发作与原发性进行性多发性硬化症之间的比例。研究队列包括 11570 名符合条件的复发发作患者和 881 名原发性进行性多发性硬化症患者。在复发发作患者（82552 患者年）中，记录了 48362 次复发。与男性相比，女性的复发频率高 17.7%。在最初的 5 年内，每年复发 0 次与每年复发≥4 次的患者中，女性与男性的比值从 2.3:1 增加到 3.3:1。随着疾病持续时间和年龄的增加（P<10(-12)），这种性别效应的幅度增大。然而，在任何特定年份无复发的复发发作多发性硬化症患者中，女性与男性的比值是原发性进行性多发性硬化症患者的两倍。与疾病持续时间相比，患者年龄是复发发生率下降的更重要决定因素（P<10(-12)）。女性比男性更容易发生更高的复发活动。然而，这种差异并不能解释原发性进行性多发性硬化症中明显较低的女性与男性的性别比例。随着时间的推移，复发活动的下降与患者年龄的关系比与疾病持续时间的关系更密切。
