早发性多发性硬化症与发病年龄对多发性硬化症神经残疾的影响。
Early onset multiple sclerosis and the effect of disease onset age on neurological disability in multiple sclerosis.
机构信息
Department of Neurology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
出版信息
Clin Neurol Neurosurg. 2023 Jan;224:107528. doi: 10.1016/j.clineuro.2022.107528. Epub 2022 Nov 23.
OBJECTIVES
The incidence of early onset multiple sclerosis (EOMS) is increasing. We therefore aimed to compare the demographic, clinical, and magnetic resonance imaging features of early onset and adult onset multiple sclerosis patients. Furthermore, the effects of age of onset were evaluated for patients who reached an expanded disability status scale (EDSS) scores of six.
PATIENTS AND METHODS
This was a retrospective study of MS patient medical charts between 1977 and 2021, which were registered in the MS database. Only patients with relapsing remitting MS longer than 1 year were included in the study. The patients included in the study were divided into the EOMS and adult onset MS (AOMS) groups. General demographic datas, clinical datas such as the characteristics of the first clinical period, the time between the first two attacks, the attack rate in the first 2 and 3 years, the treatment status, the EDSS at the first evaluation, the EDSS score at 6 month intervals, the time to reach an EDSS score of six, and magnetic resonance imaging features such brain and spinal T2 lesions were recorded.
RESULTS
Total of 3477 including 353 (10.2 %) EOMS and 3124 (89.8 %) AOMS patients were analyzed. There was no statistically significant difference in symptom patterns between the EOMS and AOMS groups ( p = 0.649). Supratentorial clinical features at first attack were more common in AOMS patients, while optic neuropathy at first attack was more common in EOMS patients. Using univariable analysis, clinical supratentorial features at first attack, clinical optic neuropathy at first attack, clinical spinal cord at fist attack, spinal cord lesions, first EDSS score, relapse in the first 3 years, and onset patterns in terms of age were found to be statistically significant risk factors. In multivariable-adjusted analysis, clinical supratentorial features at first attack, clinical spinal cord lesions at first attack, first EDSS scores relapses in the first 3 years, and onset patterns in terms of age were found to be independent risk factors for EDSS in reaching a score of six. Early treatment start was associated with reduced hazard rate of reaching an EDSS score of 6.
CONCLUSION
Onset pattern in terms of age was an independent prognostic factor for neurological disabilities in MS patients.
目的
早发型多发性硬化症（EOMS）的发病率正在增加。因此，我们旨在比较早发型和成人发病型多发性硬化症患者的人口统计学、临床和磁共振成像特征。此外，还评估了达到扩展残疾状况量表（EDSS）评分 6 分的患者的发病年龄的影响。
方法
这是一项回顾性研究，对 1977 年至 2021 年间登记在多发性硬化症数据库中的 MS 患者病历进行了研究。只有病程超过 1 年的复发性缓解型多发性硬化症患者被纳入研究。将纳入的患者分为早发型多发性硬化症（EOMS）和成人发病型多发性硬化症（AOMS）组。记录一般人口统计学数据、首次发病期的临床特征、两次首发之间的时间、前 2 年和 3 年内的发病频率、治疗状况、首次评估时的 EDSS、每 6 个月的 EDSS 评分、达到 EDSS 评分 6 分的时间以及脑和脊髓 T2 病变的磁共振成像特征。
结果
共分析了 3477 例患者，其中 353 例（10.2%）为早发型多发性硬化症（EOMS），3124 例（89.8%）为成人发病型多发性硬化症（AOMS）。EOMS 组和 AOMS 组之间的症状模式无统计学差异（p=0.649）。AOMS 患者首次发作时出现颅上临床特征更常见，而 EOMS 患者首次发作时出现视神经病变更常见。采用单变量分析，首次发作时的颅上临床特征、首次发作时的视神经病变、首次发作时的脊髓病变、脊髓病变、首次 EDSS 评分、前 3 年的复发和发病年龄模式均为统计学显著的危险因素。多变量调整分析显示，首次发作时的颅上临床特征、首次发作时的脊髓病变、首次发作时的 EDSS 评分、前 3 年的复发和发病年龄模式是达到 EDSS 评分 6 分的独立危险因素。早期开始治疗与降低达到 EDSS 评分 6 分的危险比相关。
结论
发病年龄模式是多发性硬化症患者神经功能障碍的独立预后因素。
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