Oreja-Guevara Celia, Wiendl Heinz, Kieseier Bernd C, Airas Laura
Department of Neurology, University Hospital San Carlos, IdISCC, Madrid, Spain.
Department of Neurology, University of Münster, Münster, Germany.
Ther Adv Neurol Disord. 2014 Mar;7(2):137-49. doi: 10.1177/1756285613501575.
Multiple sclerosis (MS) is a chronic, debilitating, neurodegenerative disease that has a high impact on patients' quality of life. Individuals are often diagnosed in early adulthood and are faced with the difficulty of managing their lifestyle within the context of this chronic illness. Here we review factors that influence the disease course and the challenges that might be encountered when managing patients with MS. The majority of diagnosed patients are women of childbearing age, making pregnancy-related issues a key concern. MS typically stabilizes during pregnancy and evidence suggests that the disease has no impact on the risk of complications or outcomes. However, the effect of disease-modifying therapies on outcomes is less clear, and discontinuation of treatment prior to pregnancy or when breastfeeding is recommended. Awareness of genetic risk factors is important for patients planning a family, as several genes increase the risk of MS. Further aspects that require consideration include infections, vaccinations, environmental factors, surgery and the emergence of osteoporosis. Vaccinations are generally not a risk factor for MS and may be beneficial in terms of protection against infection and reducing the number of relapses. Environmental factors such as vitamin D deficiency, low exposure to sunlight, smoking and Epstein-Barr virus infection can all negatively influence the disease course. Furthermore, osteoporosis is generally higher in patients with MS than the general population, and the risk is increased by the environmental and genetic factors associated with the disease; bone mineral density should be assessed and smoking cessation and correction of serum vitamin D levels are recommended. Finally, as patients with MS are typically young, they are at low risk of surgery-related complications, although they should be carefully monitored postoperatively. Awareness of, and planning around, these factors may minimize the impact of the disease on patients' lifestyle.
多发性硬化症（MS）是一种慢性、使人衰弱的神经退行性疾病，对患者的生活质量有很大影响。患者通常在成年早期被诊断出来，并且面临着在这种慢性病背景下管理自身生活方式的困难。在此，我们综述影响疾病进程的因素以及在管理MS患者时可能遇到的挑战。大多数被诊断的患者是育龄女性，这使得与妊娠相关的问题成为关键关注点。MS在孕期通常会稳定，并且有证据表明该疾病对并发症风险或妊娠结局没有影响。然而，疾病修正治疗对妊娠结局的影响尚不清楚，建议在怀孕前或母乳喂养时停用此类治疗。对于计划要孩子的患者而言，了解遗传风险因素很重要，因为有几个基因会增加患MS的风险。其他需要考虑的方面包括感染、疫苗接种、环境因素、手术以及骨质疏松症的出现。疫苗接种一般不是MS的风险因素，并且在预防感染和减少复发次数方面可能有益。诸如维生素D缺乏、阳光照射不足、吸烟和爱泼斯坦 - 巴尔病毒感染等环境因素都会对疾病进程产生负面影响。此外，MS患者的骨质疏松症通常比普通人群更为常见，并且与该疾病相关的环境和遗传因素会增加此风险；应该评估骨矿物质密度，建议戒烟并纠正血清维生素D水平。最后，由于MS患者通常较为年轻，他们手术相关并发症的风险较低，尽管术后仍应仔细监测。了解并围绕这些因素进行规划可能会将该疾病对患者生活方式的影响降至最低。
