Lin Wei-Sheng, Chen Ho-Min, Yang Chih-Chao, Chen Ta-Ching, Lin Jou-Wei, Lee Wang-Tso
Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, No.579, Sec. 2, County 640 Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
Health Data Research Center, National Taiwan University, Taipei, Taiwan.
Mult Scler Relat Disord. 2020 Sep;44:102379. doi: 10.1016/j.msard.2020.102379. Epub 2020 Jul 5.
The long-term outcome of optic neuritis (ON) is heterogeneous, and it appears to vary among different populations. Identification of determinants of natural history of ON would be helpful in therapeutic planning and prognostication, while relevant investigations in Asian patients were less reported. This study aims to clarify whether comorbidities and treatment in ON patients are associated with differential risks of subsequent development of multiple sclerosis (MS) or neuromyelitis optica (NMO) in Taiwan.
We conducted the nationwide population-based cohort study using data from Taiwan's National Health Insurance Research Database. Incident ON cases during 2003~2014 were followed until the end of 2015. Pediatric and adult sub-cohorts were examined separately. The associations between immune-related comorbidities or treatment and outcomes were analyzed using Cox proportional hazards models.
A total of 11,923 adult and 1365 pediatric ON patients were enrolled. The rates of subsequent development of MS were 2.7% for adult and 3.1% for pediatric ON with median follow-up duration of 6.3 and 7.3 years respectively, while 1.2% of pediatric and adult ON evolved to NMO. Comorbid systemic lupus erythematosus was associated with increased risks of subsequent development of MS in adult (adjusted hazard ratio [aHR], 2.80; 95% CI, 1.04-7.49) and pediatric ON patients (aHR, 21.65; 95% CI, 1.29-363.4). Adult ON patients were at increased risks of NMO if comorbid with myasthenia gravis (aHR, 9.13; 95% CI, 1.20-69.45) or Sjogren's syndrome (aHR, 4.71; 95% CI, 1.74-12.76).
ON could be the sentinel event linking several peripheral autoimmune comorbidities to distinct forms of central nervous system demyelination.
视神经炎（ON）的长期预后存在异质性，且在不同人群中似乎有所不同。确定ON自然史的决定因素将有助于治疗规划和预后判断，而亚洲患者的相关研究报道较少。本研究旨在阐明台湾ON患者的合并症和治疗是否与随后发生多发性硬化（MS）或视神经脊髓炎（NMO）的不同风险相关。
我们利用台湾国民健康保险研究数据库的数据进行了一项全国性的基于人群的队列研究。对2003年至2014年期间的新发ON病例进行随访直至2015年底。分别对儿童和成人亚队列进行检查。使用Cox比例风险模型分析免疫相关合并症或治疗与结局之间的关联。
共纳入11923例成人ON患者和1365例儿童ON患者。成人ON患者随后发生MS的比例为2.7%，儿童ON患者为3.1%，中位随访时间分别为6.3年和7.3年，而1.2%的儿童和成人ON进展为NMO。合并系统性红斑狼疮与成人（调整后风险比[aHR]，2.80；95%可信区间[CI]，1.04 - 7.49）和儿童ON患者随后发生MS的风险增加相关（aHR，21.65；95%CI，1.29 - 363.4）。如果成人ON患者合并重症肌无力（aHR，9.13；95%CI，1.20 - 69.45）或干燥综合征（aHR，4.71；95%CI，1.74 - 12.76），则发生NMO的风险增加。
ON可能是将几种外周自身免疫性合并症与不同形式的中枢神经系统脱髓鞘联系起来的哨兵事件。
