Ramachandran Sudarshan, Strange Richard C, Kalra Seema, Nayak Devaki, Zeegers Maurice P, Gilford Janice, Hawkins Clive P
Keele Multiple Sclerosis Research Group, Department of Neurology, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire ST4 7LN, England, United Kingdom; Department of Biochemistry, Good Hope Hospital, Heart of England Foundation Trust, Sutton Coldfield B75 7RR, England, United Kingdom.
Keele Multiple Sclerosis Research Group, Department of Neurology, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire ST4 7LN, England, United Kingdom; Institute for Science and Technology in Medicine, Keele University Medical School, Hartshill Campus, Stoke-on-Trent, ST4 7QB, England, United Kingdom.
Mult Scler Relat Disord. 2013 Apr;2(2):109-16. doi: 10.1016/j.msard.2012.09.004. Epub 2012 Oct 24.
The extended disability severity scale (EDSS) is clinically useful in assessing disability in multiple sclerosis (MS) patients. It is also being used in studies to determine how genes and environment influence disability. However, since it has a complex relationship with functional scores and mobility and is strongly determined by disease duration its use can be limiting.
Study associations of variables with progression described by time from disease onset until EDSS.
We used a variable based on below/above median time from MS onset to reach a single EDSS value to define slow or fast progression. We compared patient categorization using this variable and MSSS, and in 533 patients (EDSS 1-8) and 242 of these patients with EDSS1-4, studied associations with skin type, gender, ultraviolet radiation and MC1R Asp294His.
Classifying patients into quartiles of slow/fast progression showed mean MSSS increased with faster progression (p<0.001). For EDSS 1-8: MSSS, late onset age and childhood sunburning were associated with fast and MC1R CG/GG(294) with slow progression. Combinations of skin type (1/2 or 3/4) with childhood weekend exposure (< or ≥median) or sunburning (yes/no) were not associated with progression. However, in patients with EDSS1-4, relative to other combinations, those with no sunburning history and types 1/2 demonstrated slow progression (odds ratio=0.15, 95% CI=0.04, 0.57).
This method, though a pilot, allows study of associations of variables with EDSS. It is based on local patients and could substitute for MSSS. In patients with EDSS1-4 but not 1-8, skin type 1/2 with no history of childhood sunburning was associated with slow progression. This is compatible with the view that disability develops through a first stage dependent on inflammation.
扩展残疾严重程度量表（EDSS）在评估多发性硬化症（MS）患者的残疾情况方面具有临床实用性。它也被用于研究基因和环境如何影响残疾。然而，由于它与功能评分和活动能力之间存在复杂关系，且受疾病持续时间的强烈影响，其应用可能存在局限性。
研究从疾病发作到EDSS所描述的进展过程中各变量之间的关联。
我们使用了一个基于从MS发病到达到单个EDSS值的时间中位数上下的变量来定义进展缓慢或快速。我们比较了使用该变量和多发性硬化症综合评分量表（MSSS）对患者的分类情况，并在533例患者（EDSS 1 - 8）以及其中242例EDSS 1 - 4的患者中，研究了与皮肤类型、性别、紫外线辐射和MC1R基因Asp294His位点的关联。
将患者分为进展缓慢/快速的四分位数显示，随着进展加快，平均MSSS升高（p<0.001）。对于EDSS 1 - 8：MSSS、发病年龄晚和儿童期晒伤与进展快速相关，而MC1R基因CG/GG(294)与进展缓慢相关。皮肤类型（1/2或3/4）与儿童期周末暴露（<或≥中位数）或晒伤（是/否）的组合与进展无关。然而，在EDSS 1 - 4的患者中，相对于其他组合，无晒伤史且皮肤类型为1/2的患者进展缓慢（优势比=0.15，95%置信区间=0.04，0.57）。
这种方法虽然是初步的，但能够研究各变量与EDSS之间的关联。它基于当地患者，可替代MSSS。在EDSS 1 - 4而非1 - 8的患者中，无儿童期晒伤史且皮肤类型为1/2与进展缓慢相关。这与残疾通过依赖炎症的第一阶段发展的观点相符。
