Neuroimmunological Disorders Gene-Environment Epidemiology Laboratory, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA.
Mult Scler Relat Disord. 2019 May;30:9-16. doi: 10.1016/j.msard.2019.01.045. Epub 2019 Jan 29.
The clinical manifestation of multiple sclerosis (MS) is highly variable. Factors influencing phenotypic heterogeneity are not well known since most studies have relied on the Expanded Disability Status Scale which has modest inter/intra-rater reliability. We therefore sought to investigate other reliable and valid measures of impairment.
We constructed a retrospective cohort of 2083 relapsing remitting MS patients using electronic health records to identify prognostic factors of Timed 25-Foot Walk (lower limb disability), Performance Scales Sum (perceived global disability), and Patient Health Questionnaire 9 (a depression tool). Patients had a clinical visit between 1/1/2008 and 5/29/2012, and at least one additional visit within approximately 3 years; the cohort consisted of 16,538 visits. The outcomes and predictors were extracted from the records. Longitudinal models were conducted, and sex- and race-specific differences were explored.
Walking speeds were slower in females, black patients, ever smokers, and Medicaid/Medicare beneficiaries. Higher body mass index (BMI), older age, longer disease duration, lower median income, and higher depression scores also predicted slower walking speeds. Older age, higher BMI, lower median income, higher depression scores, ever smokers and Medicaid/Medicare beneficiaries were associated with higher global disability. Those who were of younger age, higher BMI, lower median income, ever smoked, and on Medicaid had higher depressive scores. The effect of age and BMI on depressive scores were restricted to female and white patients, respectively.
We identified multiple longitudinal predictors of disability in relapsing remitting patients. Modifiable factors (including smoking and BMI) and adverse socioeconomic conditions were independently, and negatively associated with walking speed, global disability, and depression.
多发性硬化症（MS）的临床表现高度多变。影响表型异质性的因素尚不清楚，因为大多数研究都依赖于扩展残疾状况量表，该量表的观察者内/间信度适中。因此，我们试图研究其他可靠和有效的损伤衡量标准。
我们使用电子健康记录构建了一个包含 2083 名复发缓解型多发性硬化症患者的回顾性队列，以确定定时 25 英尺步行（下肢残疾）、表现量表总和（感知总体残疾）和患者健康问卷 9（一种抑郁工具）的预后因素。患者在 2008 年 1 月 1 日至 2012 年 5 月 29 日之间进行了临床就诊，并且在大约 3 年内至少进行了一次额外就诊；该队列包括 16538 次就诊。从记录中提取了结果和预测因素。进行了纵向模型，探讨了性别和种族特异性差异。
女性、黑人患者、曾经吸烟者和医疗补助/医疗保险受益人步行速度较慢。较高的体质指数（BMI）、年龄较大、疾病持续时间较长、较低的中位数收入和较高的抑郁评分也预示着步行速度较慢。年龄较大、BMI 较高、中位数收入较低、抑郁评分较高、曾经吸烟者和医疗补助/医疗保险受益人与较高的总体残疾相关。年龄较小、BMI 较高、中位数收入较低、曾经吸烟和接受医疗补助的人抑郁评分较高。年龄和 BMI 对抑郁评分的影响分别仅限于女性和白人患者。
我们确定了复发缓解型患者残疾的多个纵向预测因素。可改变的因素（包括吸烟和 BMI）和不利的社会经济状况与步行速度、总体残疾和抑郁呈独立且负相关。
