多发性硬化症患者的感染：一项多数据库研究。
Infections in patients diagnosed with multiple sclerosis: A multi-database study.
机构信息
Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
Bristol-Myers Squibb, Summit, NJ, USA.
出版信息
Mult Scler Relat Disord. 2020 Jun;41:101982. doi: 10.1016/j.msard.2020.101982. Epub 2020 Feb 4.
BACKGROUND
Recent data on the rates of infections among patients with multiple sclerosis (MS) are sparse. The objective of this study was to quantify incidence of infections in patients with MS compared with a matched sample of patients without MS (non-MS).
METHODS
This study was conducted in two separate electronic medical databases: the United States Department of Defense (US-DOD) military health care system and the United Kingdom's Clinical Practice Research Datalink GOLD (UK-CPRD). We identified patients with a first recorded diagnosis of MS between 2001 and 2016 (UK-CPRD) or 2004 and 2017 (US-DOD) and matched non-MS patients. We identified infections recorded after the MS diagnosis date (or the matched date in non-MS patients) and calculated incidence rates (IRs) and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) by infection site and type.
RESULTS
Relative to non-MS patients, MS patients had higher rates of any infection (US-DOD IRR 1.76; 95% CI 1.72-1.80 and UK-CPRD IRR 1.25; 95% CI 1.21-1.29) and a two-fold higher rate of hospitalized infections (US-DOD IRR 2.43; 95% CI 2.23-2.63 and UK-CPRD IRR 2.00; 95% CI 1.84-2.17). IRs of any infection were higher in females compared with males in both MS and non-MS patients, while IRs of hospitalized infections were similar between sexes in both MS and non-MS patients. The IR of first urinary tract or kidney infection was nearly two-fold higher in MS compared with non-MS patients (US-DOD IRR 1.88; 95% CI 1.81-1.95 and UK-CPRD IRR 1.97; 95% CI 1.86-2.09) with higher rates in females compared with males. IRs for any opportunistic infection, candidiasis and any herpes virus were increased between 20 and 52% among MS patients compared with non-MS patients. IRs of meningitis, tuberculosis, hepatitis B and C were all low.
CONCLUSION
MS patients have an increased risk of infection, notably infections of the renal tract, and a two-fold increased risk of hospitalized infections compared with non-MS patients.
背景
最近有关多发性硬化症（MS）患者感染率的数据很少。本研究的目的是定量比较 MS 患者与非 MS 患者（非 MS）的感染发生率。
方法
本研究在两个独立的电子医疗数据库中进行：美国国防部（US-DOD）医疗保健系统和英国临床实践研究数据链接 GOLD（UK-CPRD）。我们确定了 2001 年至 2016 年（英国 CPRD）或 2004 年至 2017 年（美国 DOD）首次记录 MS 诊断的患者，并匹配了非 MS 患者。我们在 MS 诊断日期（或非 MS 患者的匹配日期）后记录了感染，并按感染部位和类型计算了感染发生率（IR）和感染发生率比（IRR）及其 95％置信区间（CI）。
结果
与非 MS 患者相比，MS 患者的任何感染率（美国 DOD IRR 1.76；95％CI 1.72-1.80 和 UK-CPRD IRR 1.25；95％CI 1.21-1.29）和住院感染率高两倍（美国 DOD IRR 2.43；95％CI 2.23-2.63 和 UK-CPRD IRR 2.00；95％CI 1.84-2.17）。MS 和非 MS 患者中，女性的任何感染发生率均高于男性，而 MS 和非 MS 患者的住院感染发生率在性别之间相似。与非 MS 患者相比，MS 患者的首次尿路感染或肾脏感染发生率高近两倍（美国 DOD IRR 1.88；95％CI 1.81-1.95 和 UK-CPRD IRR 1.97；95％CI 1.86-2.09），女性的发生率高于男性。与非 MS 患者相比，MS 患者的机会性感染，念珠菌病和任何疱疹病毒的感染率增加了 20％至 52％。脑膜炎，结核病，乙型和丙型肝炎的感染率均较低。
结论
与非 MS 患者相比，MS 患者感染的风险增加，尤其是肾脏感染的风险增加，并且住院感染的风险增加了两倍。
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