Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Neurotoxicology. 2017 Jul;61:189-212. doi: 10.1016/j.neuro.2016.03.020. Epub 2016 Apr 1.
Multiple sclerosis (MS) is a chronic disease of the central nervous system with an unidentified etiology. We systematically reviewed the literature on the possible risk factors associated with MS disease onset, relapses and progression from 1960 to 2012 by accessing six databases and including relevant systematic reviews, meta-analyses, case-control or cohort studies. The focus was on identifying modifiable risk factors. Fifteen systematic reviews and 169 original articles were quality assessed and integrated into a descriptive review. Best evidence, which included one or more prospective studies, suggested that lower exposure to sunlight and/or lower serum vitamin D levels were associated with an increased risk of developing MS onset and subsequent relapses, but a similar quality of evidence was lacking for disease progression. Prospective studies indicated that cigarette smoking may increase the risk of MS as well as accelerate disease progression, but whether smoking altered the risk of a relapse was largely unknown. Infections were implicated in both risk of developing MS and relapses, but data for progression were lacking. Specifically, exposure to the Epstein-Barr virus, particularly if this manifested as infectious mononucleosis during adolescence, was associated with increased MS risk. Upper respiratory tract infections were most commonly associated with an increase in relapses. Relapse rates typically dropped during pregnancy, but there was no strong evidence to suggest that pregnancy itself altered the risk of MS or affected long-term progression. Emerging research with the greatest potential to impact public health was the suggestion that obesity during adolescence may increase the risk of MS; if confirmed, this would be of major significance.
多发性硬化症（MS）是一种中枢神经系统的慢性疾病，其病因尚未明确。我们通过访问六个数据库，包括相关的系统评价、荟萃分析、病例对照或队列研究，对 1960 年至 2012 年与 MS 发病、复发和进展相关的可能危险因素进行了系统综述。重点是确定可改变的危险因素。对 15 项系统评价和 169 篇原始文章进行了质量评估，并将其整合到描述性综述中。最佳证据（包括一项或多项前瞻性研究）表明，暴露于阳光较少和/或血清维生素 D 水平较低与 MS 发病和随后复发的风险增加有关，但缺乏类似质量的证据表明其与疾病进展有关。前瞻性研究表明，吸烟可能会增加 MS 的风险并加速疾病的进展，但吸烟是否改变了复发的风险还很大程度上不清楚。感染与 MS 的发病和复发都有关，但缺乏疾病进展的数据。具体来说，接触 Epstein-Barr 病毒（尤其是在青少年时期表现为传染性单核细胞增多症）与 MS 风险增加有关。上呼吸道感染与复发增加最相关。复发率通常在怀孕期间下降，但没有强有力的证据表明怀孕本身会改变 MS 的风险或影响长期进展。一项具有最大潜力影响公众健康的新兴研究表明，青少年肥胖可能会增加 MS 的风险；如果得到证实，这将具有重大意义。
