Muñoz N L, Giraldo L M, Zuluaga M I, Yasno D, Bareño-Silva J
Instituto Neurológico de Colombia, Medellín, Colombia.
Universidad Militar Nueva Granada, Bogotá, Colombia.
Rev Neurol. 2022 Jun 1;74(11):347-352. doi: 10.33588/rn.7411.2021498.
Disability in neuromyelitis optica spectrum disorder (NMOSD) is common and can be severe.
To determine factors associated with increased disability in NMOSD.
Observational, analytical, ambispective study in a cohort of patients with NMOSD between January 2015 and July 2021, using a secondary source to review variables and the expanded disability status scale (EDSS) after onset and a primary source, with a telephone survey for the final EDSS and missing data. Major disability was defined as occurring when the EDSS score was = 6. The analysis was performed by means of logistic regression with SPSS 25®.
A total of 125 patients were analysed. The average age at onset was 41 (standard deviation: 14) years, with a female-to-male ratio of 8:1. Of the total sample, 87% (109) were positive for anti-aquaporin antibodies. Optic neuritis (44.8%) and transverse myelitis (39.2%) were the most frequent clinical manifestations at onset. Altogether 71.2% of patients received acute treatment at their first relapse. Mean chronic treatment initiation was 12 months (interquartile range: 3-60) and 44% had difficulties with immunosuppression compliance. Of the total number of patients, 80.8% had relapses and 44% had a final EDSS score = 6. The median baseline-to-final EDSS score was 1 (interquartile range: 0-3), often towards disability accumulation. An association was found between a relapsing course (odds ratio = 3.73; p = 0.011) and a high baseline EDSS (odds ratio = 1.54; p = 0.0001) with increased disability. In the multivariate analysis, with a higher baseline EDSS and a relapsing course disability was 1.6 and 5.3 times more likely to occur, respectively.
Disease relapses and high EDSS after the first episode are predictors of disability in NMOSD.
视神经脊髓炎谱系障碍（NMOSD）患者的残疾情况很常见且可能很严重。
确定与NMOSD患者残疾加重相关的因素。
对2015年1月至2021年7月期间的一组NMOSD患者进行观察性、分析性、双向性研究，使用二级资料回顾发病后的变量和扩展残疾状态量表（EDSS），并通过电话调查获取最终的EDSS和缺失数据。严重残疾定义为EDSS评分≥6分时出现。使用SPSS 25®软件通过逻辑回归进行分析。
共分析了125例患者。发病时的平均年龄为41岁（标准差：14岁），女性与男性的比例为8:1。在总样本中，87%（109例）抗水通道蛋白抗体呈阳性。视神经炎（44.8%）和横贯性脊髓炎（39.2%）是发病时最常见的临床表现。共有71.2%的患者在首次复发时接受了急性治疗。慢性治疗开始的平均时间为12个月（四分位间距：3 - 60个月），44%的患者在免疫抑制依从性方面存在困难。在所有患者中，80.8%有复发，44%的患者最终EDSS评分≥6分。基线至最终EDSS评分的中位数为1分（四分位间距：0 - 3分），残疾往往呈累积趋势。发现复发病程（比值比 = 3.73；p = 0.011）和高基线EDSS（比值比 = 1.54；p = 0.0001）与残疾加重相关。在多变量分析中，基线EDSS较高和复发病程导致残疾发生的可能性分别高出1.6倍和5.3倍。
疾病复发和首次发作后的高EDSS是NMOSD患者残疾的预测因素。
