Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Eur J Neurol. 2017 Apr;24(4):624-630. doi: 10.1111/ene.13262. Epub 2017 Feb 26.
The modifiable risk factor cigarette smoking has been associated with an increased risk of developing multiple sclerosis (MS) and with disease activity in relapsing-remitting MS. However, less is known about the effect of smoking on disease progression in progressive MS. Here the association between cigarette smoking and disability accumulation in primary progressive MS (PPMS) is investigated.
Kaplan-Meier survival analyses and Cox proportional hazard modelling were used to investigate the influence of cigarette smoking on the risk of reaching Expanded Disability Status Scale (EDSS) 4 and 6 as well as the time from EDSS 4 to 6 in patients with PPMS.
In all, 416 patients with PPMS and available smoking history were identified. Median time to EDSS 4 was 4 years in ever-smokers and 5 years in never-smokers (P = 0.27), and it was 9 years to EDSS 6 in both ever-smokers and never-smokers (P = 0.48). Smokers were not at increased risk of faster progression to EDSS 4, 6 and from EDSS 4 to 6. Age at disease onset was the strongest risk factor for progression to EDSS 4, 6 and from EDSS 4 to 6.
Our investigation of a large and well-characterized population based PPMS cohort suggests that cigarette smoking does not influence disability accumulation in PPMS. Our findings support the idea that PPMS is driven by different underlying pathomechanisms than relapsing-remitting MS.
可改变的风险因素吸烟与多发性硬化症（MS）的发病风险增加以及复发缓解型 MS 的疾病活动有关。然而，关于吸烟对进展型 MS 疾病进展的影响知之甚少。在此，研究了吸烟与原发性进展型 MS（PPMS）残疾累积之间的关系。
使用 Kaplan-Meier 生存分析和 Cox 比例风险模型，调查吸烟对 PPMS 患者达到扩展残疾状态量表（EDSS）4 和 6 的风险以及从 EDSS 4 到 6 的时间的影响。
共确定了 416 名具有可用吸烟史的 PPMS 患者。曾吸烟者达到 EDSS 4 的中位时间为 4 年，从不吸烟者为 5 年（P=0.27），达到 EDSS 6 的中位时间均为 9 年（P=0.48）。吸烟者进展为 EDSS 4、6 以及从 EDSS 4 到 6 的速度没有增加的风险。发病年龄是进展为 EDSS 4、6 以及从 EDSS 4 到 6 的最强危险因素。
我们对一个大型、特征良好的基于人群的 PPMS 队列进行的研究表明，吸烟不会影响 PPMS 中的残疾累积。我们的研究结果支持这样一种观点，即 PPMS 是由与复发缓解型 MS 不同的潜在发病机制驱动的。
