Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
PLoS One. 2018 Apr 24;13(4):e0196244. doi: 10.1371/journal.pone.0196244. eCollection 2018.
There are only few reports regarding the role of lifetime drug or substance use in multiple sclerosis (MS) etiology. In this study, we investigated the potential effect of drug or substance exposure on the onset of MS diagnosis. We conducted a population-based incident case control study in Tehran. Cases (n = 547) were 15-50 years old persons with MS identified from the Iranian Multiple Sclerosis Society (IMSS) register during August 7, 2013, and November 17, 2015. Population-based controls (n = 1057) were 15-50 years old and were recruited by random digit telephone dialing. Inverse-probability-of-treatment weighing (IPTW) using two sets of propensity scores (PSs) was used to estimate marginal incidence odds ratios (ORs) for MS contrasting pre-specified substance use. The estimated marginal OR was 6.03 (95% confidence interval: 3.54;10.3, using trimmed weights at the 95th percentile of the stabilized weight distribution) in both IPTW analyses comparing lifetime substance use (opioids, cannabis, inhalants, hallucinogens and stimulants) for at least one time monthly during a six-months or longer period vs. no such history of drug use. Subject to limitation of causal claims based on case-control studies, this study suggests that monthly drug or substance use for a period of at least six consecutive months, may increase the risk of MS by factor 3.5 or higher.
关于一生中药物或物质使用在多发性硬化症（MS）病因学中的作用，仅有少数报道。在这项研究中，我们调查了药物或物质暴露对 MS 诊断发作的潜在影响。我们在德黑兰进行了一项基于人群的病例对照研究。病例（n=547）为 15-50 岁的 MS 患者，是 2013 年 8 月 7 日至 2015 年 11 月 17 日期间从伊朗多发性硬化症协会（IMSS）登记处确定的。基于人群的对照（n=1057）为 15-50 岁，通过随机数字电话拨号招募。使用两组倾向评分（PS）进行逆概率治疗加权（IPTW），以对比预定义物质使用的 MS 的边际发病率比值比（OR）。在两种 IPTW 分析中，估计的边际 OR 分别为 6.03（95%置信区间：3.54；10.3），与一生中至少每月使用一次药物（阿片类药物、大麻、吸入剂、迷幻剂和兴奋剂）持续六个月或更长时间的对照相比，没有这样的药物使用史。基于病例对照研究的因果关系的局限性，本研究表明，至少连续六个月每月使用药物或物质可能使 MS 的风险增加 3.5 倍或更高。
