早发性多发性硬化症患者的生活质量和认知功能

Quality of life and cognitive functions in early onset multiple sclerosis.

作者信息

Lanzillo R, Chiodi A, Carotenuto A, Magri V, Napolitano A, Liuzzi R, Costabile T, Rainone N, Freda M F, Valerio P, Brescia Morra V

机构信息

Department of Neurosciences, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.

出版信息

Eur J Paediatr Neurol. 2016 Jan;20(1):158-63. doi: 10.1016/j.ejpn.2015.08.005. Epub 2015 Sep 3.

DOI:10.1016/j.ejpn.2015.08.005

PMID:26387071

Abstract

BACKGROUND

Multiple sclerosis (MS) is a demyelinating disease of the CNS occurring in young adults and even in children in 5% of cases. Lower quality of life (QoL) and cognitive impairment (CI) (40-54%) have been reported in early-onset MS (EO-MS) patients.

OBJECTIVE

To assess QoL and cognitive function in EO-MS and their relationship, also considering demographic and clinical variables.

METHODS

Paediatric Quality of life inventory Version 4.0 for patients aged 13-18 and 19-25 years, Beck Depression Inventory II (BDI II) and the Rao Brief Repeatable Battery were performed in EO-MS patients (onset age ≤25years). EDSS and MSSS were performed at same time. After testing for normal distribution, group comparisons were performed through the two-tailed Student's t test, one-way analysis of variance (ANOVA) and linear or logistic regression when appropriate. The Bonferroni correction for multiple testing was used when appropriate.

RESULTS

59 patients were included (mean age: 20 ± 3.6; Female sex 52.54%). 34 patients had a paediatric onset (<18 years) while 20 patients had a juvenile onset (18 < age < 25 years) of disease. 5 patients were excluded for missing data. HR-QoL was higher in paediatric than juvenile MS patients (p = 0.02), and it was inversely related to EDSS (p = 0.0005) and Multiple Sclerosis Severity score (MSSS) (p = 0.0001). Sixtyone % of patients showed a CI at BRB. No association was found between CI and any socio-demographic and clinical data. HR-QoL total score was not related to CI status nor to any domain-specific cognitive function score, even considering BDI as possible bias. CI was related to social, physical functioning score and EDSS (p = 0.01) at a logistic regression backward stepwise estimation.

CONCLUSION

HR-QoL resulted to be better in paediatric than juvenile MS onset patients and was inversely related to rapidity of disability accumulation, while cognitive impairment was influenced by physical disability and poor social involvement (school, education …). Social participation, affective relations and psychological flexibility could have a protective function on CI.

摘要

背景

多发性硬化症（MS）是一种中枢神经系统脱髓鞘疾病，多见于年轻人，5%的病例甚至发生于儿童。据报道，早发性MS（EO-MS）患者的生活质量（QoL）较低，认知障碍（CI）发生率为40%-54%。

目的

评估EO-MS患者的生活质量和认知功能及其关系，并考虑人口统计学和临床变量。

方法

对年龄在13-18岁和19-25岁的EO-MS患者（发病年龄≤25岁）进行儿童生活质量量表第4版、贝克抑郁量表第二版（BDI II）和Rao简短可重复成套测验。同时进行扩展残疾状态量表（EDSS）和多发性硬化症严重程度量表（MSSS）评估。在检验数据是否呈正态分布后，若数据符合正态分布，通过双尾t检验、单因素方差分析（ANOVA）进行组间比较，在适当情况下进行线性或逻辑回归分析。在适当情况下，采用Bonferroni多重检验校正。

结果

纳入59例患者（平均年龄：20±3.6岁；女性占52.54%）。34例患者为儿童期发病（<18岁），20例患者为青少年期发病（18<年龄<25岁）。5例患者因数据缺失被排除。儿童期MS患者的健康相关生活质量（HR-QoL）高于青少年期MS患者（p=0.02），且与EDSS（p=0.0005）和多发性硬化症严重程度评分（MSSS）（p=0.0001）呈负相关。61%的患者在Rao简短可重复成套测验中表现出认知障碍。未发现认知障碍与任何社会人口统计学和临床数据之间存在关联。即使将BDI视为可能的偏倚因素，HR-QoL总分也与认知障碍状态及任何特定领域的认知功能评分均无关。在逻辑回归向后逐步估计中，认知障碍与社会、身体功能评分及EDSS相关（p=0.01）。