多发性硬化症患者的扁桃体切除术：回顾性、病例对照、探索性研究。
Tonsillectomy in multiple sclerosis patients: Retrospective, case-controlled, exploratory study.
作者信息
Jakimovski Dejan, Ahmed Muhammad K, Vaughn Caila B, Zivadinov Robert, Weinstock-Guttman Bianca
机构信息
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, State University of New York at Buffalo, NY, USA; Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
Jacobs MS Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
出版信息
Mult Scler Relat Disord. 2020 Jul;42:102131. doi: 10.1016/j.msard.2020.102131. Epub 2020 Apr 28.
BACKGROUND
Previous studies have shown an effect of tonsillectomy and greater risk for future autoimmune diseases. Currently there are only few outdated analyses of tonsillectomy and multiple sclerosis (MS) risk.
OBJECTIVE
To investigate the prevalence of tonsillectomy in MS patients and healthy controls (HCs).
METHODS
A total of 1000 subjects (779 MS patients and 221 HCs) completed a structured study questionnaire regarding MS diagnosis, age of onset, history of tonsillectomy, and age of tonsillectomy. In a subgroup of patients with available electronic medical records, Expanded Disability Status Scale (EDSS) scores at the time of recruitment and 5-years later were collected. Statistical analyses were performed with χ test, odds ratio (OR), Student's t-test, Mann-Whitney U test, and ordinal regression..
RESULTS
The MS population had a greater percentage of patients with history of tonsillectomy when compared to HCs [39.5% vs. 31.7%, OR 1.411 (CI 1.027-1.938), p = 0.034], driven by participants aged 50 or older [45.7% vs. 36.1%, OR 1.495 (CI 1.037-2.155) p = 0.031]. There was no difference of the age at tonsillectomy (median 8.0 vs. 6.5 years old, p = 0.26). However, the RRMS patients had their tonsillectomy procedure performed significantly later when compared to HCs (median 6.5 vs. 9.0 years old, p = 0.049). In an analysis of RRMS patients with available longitudinal data (n = 459), patients with a history of tonsillectomy were significantly older and had a longer disease duration (p < 0.001 and p = 0.025). After adjusting for the demographic differences, no history of tonsillectomy remained significant predictor of lower EDSS score categories both at the first (estimate = -0.467, Wald = 6.68, 95% CI -0.82 to -0.11, p = 0.01) and second timepoint (estimate = -0.376, Wald = 4.4, 95% CI -0.73 to -0.02 p = 0.037).
CONCLUSION
When compared to HCs, a greater percentage of MS patients underwent tonsillectomy. The role of tonsils, its relationship with early infection rates and/or antibiotic use in MS should be further investigated.
背景
既往研究显示扁桃体切除术存在一定影响，且未来患自身免疫性疾病的风险更高。目前关于扁桃体切除术与多发性硬化症（MS）风险的分析较少且过时。
目的
调查MS患者和健康对照者（HCs）中扁桃体切除术的患病率。
方法
共有1000名受试者（779例MS患者和221例HCs）完成了一份关于MS诊断、发病年龄、扁桃体切除术史及扁桃体切除年龄的结构化研究问卷。在有可用电子病历的患者亚组中，收集了入组时及5年后的扩展残疾状态量表（EDSS）评分。采用χ检验、比值比（OR）、学生t检验、曼-惠特尼U检验和有序回归进行统计分析。
结果
与HCs相比，MS患者中有扁桃体切除术史的患者比例更高[39.5%对31.7%，OR 1.411（CI 1.027 - 1.938），p = 0.034]，这一差异由50岁及以上的参与者驱动[45.7%对36.1%，OR 1.495（CI 1.037 - 2.155），p = 0.031]。扁桃体切除年龄无差异（中位数8.0岁对6.5岁，p = 0.26）。然而，复发缓解型多发性硬化症（RRMS）患者的扁桃体切除术明显比HCs患者晚（中位数6.5岁对9.0岁，p = 0.049）。在对有可用纵向数据的RRMS患者（n = 459）进行的分析中，有扁桃体切除术史的患者年龄明显更大且病程更长（p < 0.001和p = 0.025）。在调整人口统计学差异后，扁桃体切除术史在首次（估计值 = -0.467，Wald = 6.68，95%CI -0.82至-0.11，p = 0.01）和第二次时间点（估计值 = -0.376，Wald = 4.4，95%CI -0.73至-0.02，p = 0.037）均不再是较低EDSS评分类别的显著预测因素。
结论
与HCs相比，接受扁桃体切除术的MS患者比例更高。扁桃体在MS中的作用及其与早期感染率和/或抗生素使用的关系应进一步研究。
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