Department of Neurology, MS Centre ErasMS, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands.
J Neurol. 2018 May;265(5):1010-1015. doi: 10.1007/s00415-018-8780-4. Epub 2018 Feb 20.
Cigarette smoking is a modifiable risk factor that influences the disease course of patients with multiple sclerosis (MS). However, in patients with a clinically isolated syndrome (CIS), there are conflicting results about the association between smoking and the risk of a subsequent MS diagnosis. The aim of this study was to determine the risk of clinically definite MS (CDMS) in smoking and non-smoking patients at time of a first demyelinating event.
Two hundred and fifty patients, aged 18-50 years, were included in our prospective CIS cohort. At time of the first neurological symptoms, patients completed a questionnaire about smoking habits. Cox regression analyses were performed to calculate univariate and multivariate hazard ratios for CDMS diagnosis in smoking and non-smoking CIS patients.
One hundred and fourteen (46%) CIS patients were diagnosed with CDMS during a mean follow-up of 58 months. In total, 79 (32%) patients smoked at time of CIS. Sixty-seven % of the smoking CIS patients were diagnosed with CDMS during follow-up compared to 36% of the non-smoking CIS patients (p < 0.001). Smoking at time of CIS was an independent predictor for CDMS diagnosis (HR 2.3; p = 0.002). Non-smoking CIS patients who had a history of smoking did not have a higher risk for CDMS than those who had never smoked.
Smoking at time of CIS was an independent risk factor for a future CDMS diagnosis. This is an additional argument to quit smoking at time of the first attack of suspected MS.
吸烟是一种可改变的风险因素，会影响多发性硬化症（MS）患者的疾病进程。然而，在临床孤立综合征（CIS）患者中，吸烟与随后发生 MS 诊断的风险之间的关联存在相互矛盾的结果。本研究的目的是确定在首次脱髓鞘事件时吸烟和不吸烟患者发生临床确诊多发性硬化症（CDMS）的风险。
我们前瞻性地纳入了 250 名年龄在 18-50 岁之间的 CIS 患者。在首次出现神经症状时，患者完成了一份关于吸烟习惯的问卷。使用 Cox 回归分析计算吸烟和不吸烟 CIS 患者发生 CDMS 诊断的单变量和多变量危险比。
114 名（46%）CIS 患者在平均 58 个月的随访中被诊断为 CDMS。共有 79 名（32%）CIS 患者在发病时吸烟。在随访期间，吸烟的 CIS 患者中有 67%被诊断为 CDMS，而非吸烟的 CIS 患者中有 36%被诊断为 CDMS（p<0.001）。CIS 时吸烟是 CDMS 诊断的独立预测因素（HR 2.3；p=0.002）。从未吸烟的 CIS 患者中，有吸烟史的患者发生 CDMS 的风险并不高于从未吸烟的患者。
CIS 时吸烟是未来发生 CDMS 的独立危险因素。这是在疑似 MS 首次发作时戒烟的另一个理由。
