Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Department of Pediatric Neurology, Center of Pediatrics and Adolescent Medicine, Central Hospital Bremen, Bremen, Germany.
Front Immunol. 2022 Aug 2;13:937583. doi: 10.3389/fimmu.2022.937583. eCollection 2022.
The pathogenesis of multiple sclerosis (MS) has not yet been fully uncovered. There is increasing evidence that Epstein-Barr-Virus (EBV) infection, which affects over 90% of people during life and causes infectious mononucleosis, leads to an increased incidence of MS, and thus may play a crucial role in the pathophysiology of the disease.
Using the Disease Analyzer database (IQVIA) featuring diagnoses as well as basic medical and demographic data of outpatients from general practices in Germany, we identified a total of 16,058 patients with infectious mononucleosis that were matched to a cohort of equal size without infectious mononucleosis based on patients' age, sex, index year and yearly consultation frequency. Incidence of MS was compared within a 10-year follow-up period.
Within 10 years from the index date, the incidence of MS was 22.6 cases per 100,000 person-years among patient with infectious mononucleosis but only 11.9 cases per 100,000 person-years among individuals without infectious mononucleosis. In regression analysis, infectious mononucleosis was significantly associated with the incidence of MS (HR: 1.86, 95% CI: 1.09-3.16). Subgroup analysis revealed the strongest association between infectious mononucleosis and MS in the age group between 14 and 20 years (HR: 3.52, 95% CI: 1.00-12.37) as well as a stronger association in men compared to women.
Infectious mononucleosis is associated with an increased incidence of MS especially in younger individuals. Our data support the growing evidence of a decisive involvement of EBV in the currently unknown pathophysiology of MS and should trigger further research efforts to better understand and potentially prevent cases of this disabling disease in future.
多发性硬化症（MS）的发病机制尚未完全阐明。越来越多的证据表明，影响超过 90%的人在生活中导致传染性单核细胞增多症的 Epstein-Barr 病毒（EBV）感染，导致 MS 的发病率增加，因此可能在疾病的病理生理学中起关键作用。
我们使用 IQVIA 的疾病分析器数据库（Disease Analyzer database），该数据库具有德国普通诊所的诊断以及基本医疗和人口统计数据，共确定了 16058 例传染性单核细胞增多症患者，根据患者的年龄、性别、索引年和每年就诊次数与一组大小相等的没有传染性单核细胞增多症的患者相匹配。比较了 10 年随访期间 MS 的发病率。
在索引日期后的 10 年内，患有传染性单核细胞增多症的患者中 MS 的发病率为每 100,000 人年 22.6 例，而没有传染性单核细胞增多症的患者中 MS 的发病率为每 100,000 人年 11.9 例。在回归分析中，传染性单核细胞增多症与 MS 的发病显著相关（HR：1.86，95%CI：1.09-3.16）。亚组分析显示，传染性单核细胞增多症与 MS 之间的关联在 14 至 20 岁年龄组最强（HR：3.52，95%CI：1.00-12.37），且男性的关联强于女性。
传染性单核细胞增多症与 MS 的发病率增加有关，尤其是在年轻人群中。我们的数据支持 EBV 在目前未知的 MS 病理生理学中起决定性作用的证据越来越多，应促使进一步研究，以更好地了解和潜在地预防未来这种使人丧失能力的疾病。
