Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark.
J Neurol Neurosurg Psychiatry. 2022 Jul;93(7):716-722. doi: 10.1136/jnnp-2022-328994. Epub 2022 Apr 7.
To quantify sex differences in activity and severity of multiple sclerosis (MS) and how it depends on disease duration and time since clinical onset.
All Danish citizens with onset of relapsing MS since 1996 who have received disease-modifying therapy have been followed with annual or biannual control visits with mandatory notification of the Danish Multiple Sclerosis Registry. Men and women were compared by the inverse probability of being female. Relapse rates and changes in the Expanded Disability Status Scale (EDSS) scores were analysed with weighted general linear models, and we used weighted Cox regression for HRs between men and women for different EDSS endpoints.
We included 3028 men and 6619 women. The weighted female:male relapse rate ratio was 1.16 (95% CI: 1.10 to 1.22) but after age 50 years, the difference disappeared. The annualised increase in EDSS was 0.07 in men (95% CI: 0.05 to 0.08) and 0.05 in women (95% CI: 0.04 to 0.06); p=0.017. With women as reference, the HR for reaching EDSS 4 was 1.34 (95% CI: 1.23 to 1.45; p<0.001), and for reaching EDSS 6 it was 1.43 (95% CI: 1.28 to 1.61; p<0.001). The diagnostic delay did not differ significantly between the sexes.
Women have more inflammatory disease activity in terms of relapses than men up to the age of menopause indicating that sex hormones may play a role. Men are more subject to the neurodegenerative component of MS than women, particularly after the age of 45 years.
量化多发性硬化症（MS）在活动和严重程度上的性别差异，以及这种差异如何随疾病持续时间和临床发病后时间而变化。
自 1996 年以来，所有丹麦籍发病为复发性 MS 且接受过疾病修正治疗的患者都通过年度或每两年一次的控制就诊进行随访，并且必须向丹麦多发性硬化症登记处报告。通过反概率的方法来比较男性和女性。使用加权广义线性模型分析复发率和扩展残疾状态量表（EDSS）评分的变化，并使用加权 Cox 回归分析男性和女性不同 EDSS 终点之间的 HR。
共纳入 3028 名男性和 6619 名女性。加权女性：男性复发率比值为 1.16（95%CI：1.10 至 1.22），但在 50 岁以后，差异消失。男性 EDSS 的年增长率为 0.07（95%CI：0.05 至 0.08），女性为 0.05（95%CI：0.04 至 0.06）；p=0.017。以女性为参照，达到 EDSS 4 的 HR 为 1.34（95%CI：1.23 至 1.45；p<0.001），达到 EDSS 6 的 HR 为 1.43（95%CI：1.28 至 1.61；p<0.001）。男女之间的诊断延迟差异无统计学意义。
女性在绝经前的复发次数比男性更多，表明性激素可能起作用。男性比女性更容易受到 MS 的神经退行性成分的影响，特别是在 45 岁以后。
