Wu Jing, Olsson Tomas, Hillert Jan A, Alfredsson Lars, Hedström Anna Karin
From the Institute of Environmental Medicine (J.W., L.A.); Department of Clinical Neuroscience (T.O., J.A.H., L.A., A.K.H.), Karolinska Institutet; and Centre for Occupational and Environmental Medicine (L.A.), Region Stockholm, Stockholm, Sweden.
Neurol Neuroimmunol Neuroinflamm. 2024 Sep;11(5):e200289. doi: 10.1212/NXI.0000000000200289. Epub 2024 Jul 31.
Previous studies have indicated that alcohol consumption is associated with multiple sclerosis (MS) disease progression. We aimed to study the influence of alcohol consumption habits on disease progression and health-related quality of life in MS.
We categorized patients from 2 population-based case-control studies by alcohol consumption habits at diagnosis and followed them up to 15 years after diagnosis through the Swedish MS registry regarding changes in the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Impact Scale 29 (MSIS-29). We used Cox regression models with 95% confidence intervals (CIs) using 24-week confirmed disability worsening, EDSS 3, EDSS 4, and physical and psychological worsening from the patient's perspective as end points.
Our study comprised 9,051 patients with MS, with a mean age of 37.5 years at baseline/diagnosis. Compared with nondrinking, low and moderate alcohol consumption was associated with reduced risk of EDSS-related unfavorable outcomes (hazard ratios between 0.81 and 0.90) and with reduced risk of physical worsening. The inverse association was confined to relapsing-remitting MS and was more pronounced among women. High alcohol consumption did not significantly affect disease progression. The inverse relationship between low-moderate alcohol consumption and disability progression became stronger when we only included those who had not changed their alcohol consumption during follow-up (hazard ratios between 0.63 and 0.71). There were no differences in measures of disability at baseline between drinkers who continued drinking alcohol after diagnosis and those who later discontinued. Our findings speak against bias due to reverse causation.
Low and moderate alcohol consumption was associated with more favorable outcomes in relapsing-remitting MS, compared with nondrinking, while there was no significant influence of high alcohol consumption on disease outcomes.
既往研究表明，饮酒与多发性硬化症（MS）的疾病进展相关。我们旨在研究饮酒习惯对MS疾病进展及健康相关生活质量的影响。
我们根据诊断时的饮酒习惯，对两项基于人群的病例对照研究中的患者进行分类，并通过瑞典MS登记处对他们进行诊断后长达15年的随访，了解扩展残疾状态量表（EDSS）和多发性硬化症影响量表29（MSIS - 29）的变化。我们使用Cox回归模型，以24周确诊的残疾恶化、EDSS 3、EDSS 4以及患者视角下的身体和心理恶化作为终点，95%置信区间（CIs）。
我们的研究包括9051例MS患者，基线/诊断时的平均年龄为37.5岁。与不饮酒相比，低剂量和中等剂量饮酒与EDSS相关不良结局风险降低（风险比在0.81至0.90之间）以及身体恶化风险降低相关。这种负相关仅限于复发缓解型MS，在女性中更为明显。高剂量饮酒对疾病进展没有显著影响。当我们仅纳入随访期间饮酒习惯未改变的患者时，低至中等剂量饮酒与残疾进展之间的负相关关系变得更强（风险比在0.63至0.71之间）。诊断后继续饮酒的饮酒者与后来戒酒的饮酒者在基线时的残疾测量指标上没有差异。我们的研究结果反对反向因果导致的偏差。
与不饮酒相比，低至中等剂量饮酒与复发缓解型MS更有利的结局相关，而高剂量饮酒对疾病结局没有显著影响。
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