Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy.
Eur J Neurol. 2018 Dec;25(12):1425-1431. doi: 10.1111/ene.13745. Epub 2018 Aug 3.
Late-onset multiple sclerosis (MS) has a prevalence of about 10-20% in natural history MS studies. Few data have been published about the long-term disease trajectory in the cohort of late-onset relapsing-remitting MS (LORRMS). The aim of this study was to identify the risk factors for reaching an Expanded Disability Status Scale (EDSS) score of 6.0 in LORRMS (onset at >40 years of age) and young-onset relapsing-remitting MS (YORRMS) (onset between 18 and 40 years of age).
Clinical and radiological [magnetic resonance imaging (MRI) of the brain] follow-up data were collected. Disability was assessed by EDSS score. A Cox proportional hazards model was used to evaluate the demographic and clinical predictors of reaching an EDSS score of 6.0 in the two cohorts.
A total of 671 patients with relapsing-remitting MS were enrolled, 143 (21.3%) with LORRMS and 528 (78.7%) with YORRMS. In LORRMS, age at onset was 47.8 ± 5.3 (mean ± SD) years and duration of follow-up was 120.7 ± 52.7 months. In YORRMS, age at onset was 27 ± 2.7 years and duration of follow-up was 149.9 ± 92.7 months. The survival curve analyses showed a higher probability of reaching an EDSS score of 6.0 for LORRMS in a shorter time (months) than for YORRMS (94.2 vs. 103.2 months; log-rank 8.8; P < 0.05). On MRI, YORRMS showed more brain inflammatory features than LORRMS. In the multivariate Cox model, age at onset [Exp(B) value, 6.5; 95% confidence interval, 1.9-22.6; P < 0.001] and male gender [Exp(B) value, 1.7; 95% confidence interval, 1.0-2.8; P < 0.05] were the strongest predictors of reaching an EDSS score of 6.0.
The male population with LORRMS reached severe disability faster than those with YORRMS, even when YORRMS showed more brain inflammatory features on MRI.
在自然病史 MS 研究中，迟发性多发性硬化症（MS）的患病率约为 10-20%。关于迟发性复发缓解型 MS（LORRMS）队列的长期疾病轨迹，发表的数据很少。本研究旨在确定在迟发性复发缓解型 MS（发病年龄＞40 岁）和年轻发病型复发缓解型 MS（YORRMS）（发病年龄 18-40 岁）中达到扩展残疾状态量表（EDSS）评分 6.0 的风险因素。
收集临床和放射学（脑部磁共振成像 [MRI]）随访数据。残疾程度通过 EDSS 评分进行评估。使用 Cox 比例风险模型评估两个队列中达到 EDSS 评分 6.0 的人口统计学和临床预测因素。
共纳入 671 例复发缓解型 MS 患者，其中 143 例（21.3%）为 LORRMS，528 例（78.7%）为 YORRMS。在 LORRMS 中，发病年龄为 47.8±5.3（均值±标准差）岁，随访时间为 120.7±52.7 个月。在 YORRMS 中，发病年龄为 27±2.7 岁，随访时间为 149.9±92.7 个月。生存曲线分析显示，LORRMS 达到 EDSS 评分 6.0 的概率更高，时间（月）更短，而 YORRMS 则更长（94.2 与 103.2 个月；对数秩检验 8.8；P＜0.05）。在 MRI 上，YORRMS 显示出比 LORRMS 更多的脑炎症特征。在多变量 Cox 模型中，发病年龄[Exp（B）值，6.5；95%置信区间，1.9-22.6；P＜0.001]和男性性别[Exp（B）值，1.7；95%置信区间，1.0-2.8；P＜0.05]是达到 EDSS 评分 6.0 的最强预测因素。
与 YORRMS 相比，LORRMS 中的男性人群更快达到严重残疾，即使 YORRMS 在 MRI 上显示出更多的脑炎症特征。
