Pupillo Elisabetta, Poloni Marco, Bianchi Elisa, Giussani Giorgia, Logroscino Giancarlo, Zoccolella Stefano, Chiò Adriano, Calvo Andrea, Corbo Massimo, Lunetta Christian, Marin Benoit, Mitchell Douglas, Hardiman Orla, Rooney James, Stevic Zorica, Bandettini di Poggio Monica, Filosto Massimiliano, Cotelli Maria Sofia, Perini Michele, Riva Nilo, Tremolizzo Lucio, Vitelli Eugenio, Damiani Danira, Beghi Ettore
a Laboratorio di Malattie Neurologiche , IRCCS-Istituto Mario Negri , Milano , Italy.
b Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.
Amyotroph Lateral Scler Frontotemporal Degener. 2018 Feb;19(1-2):118-125. doi: 10.1080/21678421.2017.1386687. Epub 2017 Oct 24.
To assess the association between amyotrophic lateral sclerosis (ALS) and previous traumatic events, age of trauma, and site of injury.
A population-based case-control study was performed in five European countries (Italy, Ireland, France, United Kingdom, Serbia). Newly diagnosed ALS patients and matched controls were interviewed to collect relevant demographic factors and exposures. Key clinical features at diagnosis were collected in ALS patients. Trauma was any accidental event causing an injury. Injuries were dated and classified according to cause, severity, type, site, and complications. All exposures were censored five years before symptoms onset. Risks were computed as odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariate conditional logistic regression models.
Five hundred and seventy-five ALS patients and 1150 controls were interviewed. Disabling traumatic events predominated in the cases (OR 1.54 (95% CI 1.24-1.92)) and maintained significance after adjustment, with a significant gradient. A history of 2 + head injuries was associated with an almost three-fold increased risk of ALS. The risk was almost two-fold when trauma occurred at age 35-54 years. Site of injury was uneventful.
Traumatic events leading to functional disability or confined to the head are risk factors for ALS. Traumatic events experienced at age 35-54 years carry the highest risk.
评估肌萎缩侧索硬化症（ALS）与既往创伤性事件、创伤年龄及损伤部位之间的关联。
在五个欧洲国家（意大利、爱尔兰、法国、英国、塞尔维亚）开展了一项基于人群的病例对照研究。对新诊断的ALS患者及匹配的对照者进行访谈，以收集相关人口统计学因素和暴露情况。收集ALS患者诊断时的关键临床特征。创伤是指任何导致受伤的意外事件。根据病因、严重程度、类型、部位及并发症对损伤进行记录和分类。所有暴露情况均在症状出现前五年进行审查。使用单变量和多变量条件逻辑回归模型计算风险，以比值比（OR）及95%置信区间（CI）表示。
共访谈了575例ALS患者和1150例对照者。致残性创伤性事件在病例组中占主导（OR 1.54（95%CI 1.24 - 1.92）），调整后仍具有显著性，且存在显著梯度。有2次及以上头部损伤史与ALS风险增加近三倍相关。创伤发生在35 - 54岁时，风险几乎增加两倍。损伤部位无明显差异。
导致功能残疾或局限于头部的创伤性事件是ALS的危险因素。35 - 54岁经历的创伤性事件风险最高。
