Weinshenker B G, Ebers G C
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
Can J Neurol Sci. 1987 Aug;14(3):255-61. doi: 10.1017/s0317167100026573.
Studies which have attempted to define the outcome of multiple sclerosis (MS) have methodologic difficulties arising from patient referral biases and the length of follow-up required, which make prospective studies of an inception cohort unrealistic. Means to improve the validity of retrospective natural history studies are suggested. Results of existing series are summarized and compared. Survival is only rarely shortened by MS, but disability to the point of requiring aids for ambulation occurs in 30-70% of patients by 15 years from onset of symptoms. Disagreement as to the percentage of patients who are ultimately bedridden by MS likely arises in large part due to differences in patient ascertainment and follow-up. The need to develop early clinical markers for the patient at high risk for rapid development of major disability is stressed.
试图界定多发性硬化症（MS）预后的研究存在方法学上的困难，这些困难源于患者转诊偏倚以及所需的随访时间，这使得对起始队列进行前瞻性研究不切实际。文中提出了提高回顾性自然史研究有效性的方法。对现有系列研究的结果进行了总结和比较。MS很少会缩短生存期，但从症状出现起15年内，30% - 70%的患者会出现残疾到需要借助辅助器具行走的程度。对于最终因MS而卧床的患者比例存在分歧，这很可能在很大程度上是由于患者确定和随访方式的不同。强调了需要为有快速发展为严重残疾高风险的患者开发早期临床标志物。
