Börü Ülkü Türk, Bilgiç Adnan Burak, Köseoğlu Toksoy Cansu, Yılmaz Abdullah Yasir, Tasdemir Mustafa, Sensöz Nilay Padir, Öztop Çakmak Özgür, Duman Arda, Bölük Cem
Department of Neurology, University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
Department of Public Health, Istanbul Medeniyet University, Istanbul, Turkey.
J Clin Neurol. 2018 Apr;14(2):234-241. doi: 10.3988/jcn.2018.14.2.234.
Multiple sclerosis (MS) is an autoimmune disease characterized by inflammatory demyelination. Recent studies have shown that long-term exposure to air pollutants (including PM10 particulates) is potentially an environmental risk factor for MS. We aimed to determine the prevalence rates of MS in two cities with different levels of air pollution.
This door-to-door population-based study was conducted between April 2014 and June 2015. Two cities were screened for the prevalence rates of MS: 1) Karabük, which borders an iron-and-steel factory, and 2) Akçakoca, which is a coastal city located in the same region. A validated survey form was used for screening MS. The 2010 McDonald Criteria were used for diagnosing MS. The patients were examined twice, first by a neurology assistant in the field and then by a senior neurologist in public health centers in the cities.
The prevalence of MS was 95.9/100,000 in Karabük and 46.1/100,000 in Akçakoca. In total, 33 patients were diagnosed with clinically definite MS. The female/male ratio was 1.5, and 21 patients were diagnosed with relapsing-remitting MS, 9 with secondary progressive MS, and 3 with primary progressive MS.
We found that the prevalence of MS was more than two fold higher in Karabük than in Akçakoca, which supports a link between air pollution and the pathogenesis of MS. However, larger etiological and epidemiological studies are needed to confirm this hypothesis.
多发性硬化症（MS）是一种以炎症性脱髓鞘为特征的自身免疫性疾病。近期研究表明，长期暴露于空气污染物（包括PM10颗粒）可能是MS的一个环境风险因素。我们旨在确定空气污染水平不同的两个城市中MS的患病率。
这项基于人群的挨家挨户调查研究于2014年4月至2015年6月进行。对两个城市进行了MS患病率筛查：1）与一家钢铁厂接壤的卡拉比克；2）位于同一地区的沿海城市阿克恰科卡。使用经过验证的调查问卷筛查MS。采用2010年麦克唐纳标准诊断MS。患者接受了两次检查，首先由现场的神经科助理进行检查，然后由城市公共卫生中心的资深神经科医生进行检查。
卡拉比克的MS患病率为95.9/10万，阿克恰科卡为46.1/10万。共有33例患者被诊断为临床确诊的MS。女性/男性比例为1.5，21例患者被诊断为复发缓解型MS，9例为继发进展型MS，3例为原发进展型MS。
我们发现卡拉比克的MS患病率比阿克恰科卡高出两倍多，这支持了空气污染与MS发病机制之间的联系。然而，需要更大规模的病因学和流行病学研究来证实这一假设。
