吸烟对 AQP4 阳性视神经脊髓炎谱系障碍、MOG-Ab 病和多发性硬化残疾模式和复发风险的影响。
The influence of smoking on the pattern of disability and relapse risk in AQP4-positive Neuromyelitis Optica Spectrum Disorder, MOG-Ab Disease and Multiple Sclerosis.
机构信息
Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK; Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK. Electronic address: https://twitter.com/silvia06.
Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
出版信息
Mult Scler Relat Disord. 2021 Apr;49:102773. doi: 10.1016/j.msard.2021.102773. Epub 2021 Jan 19.
BACKGROUND
the role of smoking on clinical outcomes of central nervous system (CNS) inflammatory disorders is unclear. To assess the effect of smoking on relapses and disability in neuromyelitis optica with aquaporin-4-antibodies (NMOSD-AQP4-Ab), Myelin Oligodendrocyte Glycoprotein-antibodies associated disease (MOGAD) and relapsing remitting Multiple Sclerosis (MS) patients.
METHODS
in a UK cohort of 101 NMOSD-AQP4-Ab, 70 MOGAD and 159 MS, and a Korean cohort of 97 NMOSD-AQ4-Ab, time to first relapse, annualised relapse rate, onset relapse severity and recovery, time to Expanded Disability Status Score(EDSS)/secondary progressive MS (SPMS) were compared between never-smokers and ever-smokers. All clinical data were collected under the local ethics between January 2017 and January 2019.
RESULTS
Smoking did not affect the risk of relapse in any of the diseases. The risk of reaching EDSS 6.0 in the UK NMOSD-AQP4-Ab cohort was higher in ever smokers but this did not achieve significance (HR 2.12, p=0.068). When combining the UK and Korea NMOSD-AQP4-Ab cohorts, poorer recovery from the onset attack was significantly more frequent in the ever-smokers versus the never smokers (55% vs 38%, p=0.04). In the MS cohort the risk of reaching EDSS 6 and SPMS was significantly higher in the ever-smokers (HR=2.67, p=0.01 and HR=3.18, p=0.001). In MOGAD similar patterns were seen without reaching significance.
CONCLUSIONS
In NMOSD-AQP4-Ab smoking associates with worse disability not through an increased risk of relapses but through poor relapse recovery. As in MS, smoking cessation should be encouraged in NMOSD-AQP4-Ab.
背景
吸烟对中枢神经系统（CNS）炎症性疾病的临床结果的影响尚不清楚。本研究旨在评估吸烟对水通道蛋白 4 抗体（AQP4-Ab）相关视神经脊髓炎（NMOSD）、髓鞘少突胶质细胞糖蛋白抗体（MOGAD）相关疾病和复发性缓解型多发性硬化（RRMS）患者复发和残疾的影响。
方法
本研究纳入了一个英国队列（101 例 NMOSD-AQP4-Ab、70 例 MOGAD 和 159 例 RRMS）和一个韩国队列（97 例 NMOSD-AQP4-Ab），比较了从不吸烟者和吸烟者之间首次复发时间、年复发率、发作复发严重程度和恢复情况、扩展残疾状态评分（EDSS）/继发性进展型多发性硬化（SPMS）时间。所有临床数据均于 2017 年 1 月至 2019 年 1 月在当地伦理委员会的监督下收集。
结果
吸烟并未影响任何疾病的复发风险。英国 NMOSD-AQP4-Ab 队列中，从未吸烟者进展为 EDSS6.0 的风险更高，但差异无统计学意义（HR 2.12，p=0.068）。当将英国和韩国 NMOSD-AQP4-Ab 队列合并后，吸烟者从首发发作中恢复的情况较差，与从不吸烟者相比更频繁（55% vs 38%，p=0.04）。在 MS 队列中，吸烟者达到 EDSS6 和 SPMS 的风险明显更高（HR=2.67，p=0.01 和 HR=3.18，p=0.001）。在 MOGAD 中，也出现了相似的模式，但差异无统计学意义。
结论
在 NMOSD-AQP4-Ab 中，吸烟与残疾加重相关，并非通过增加复发风险，而是通过降低复发后的恢复情况。与 MS 一样，NMOSD-AQP4-Ab 患者也应鼓励戒烟。
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