索马里裔美国人的多发性硬化症：先天还是后天？
Multiple sclerosis in Somali Americans: Nature or nurture?
机构信息
Department of Neurology, Mayo Clinic, Rochester, MN, USA; Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA.
出版信息
Mult Scler Relat Disord. 2024 Oct;90:105842. doi: 10.1016/j.msard.2024.105842. Epub 2024 Aug 29.
BACKGROUND
Differences in the MS course between White and Black populations is well accepted. The existence of a large Somali immigrant population in Minnesota facilitates a study of MS characteristics in this immigrant native African population. The objective of this study was to compare Somali American (SA), African American (AA), and White American (WA) persons with MS (pwMS) regarding clinical features and disease modifying therapy (DMT) use.
METHODS
This single center (Mayo Clinic) geographically-restricted retrospective cohort study (residing within 250 miles of Rochester, MN, USA) included participants seen before May 2023. Age at immigration to the USA; age at MS onset; DMT use/type; MS phase/phenotype; age at progressive MS (PMS) onset; and proportion with severe MS (expanded disability status scale-EDSS ≥6) were examined.
RESULTS
18 SApwMS, 92 AApwMS, and 94 WApwMS were included. Of the 15 SApwMS not born in USA, 3/15 immigrated pre-puberty, 3/15 peri‑puberty, 8/15 post-puberty, and 1/15 at an unknown date. SApwMS were younger at MS onset (median years, interquartile range (IQR)=25, 22-33 vs. AApwMS: 31, 25-38; p = 0.049 vs. WApwMS: 35, 27-41; p = 0.022). DMT use frequencies were 13/19 SApwMS, 69/92 AApwMS, 80/94 WApwMS (p > 0.05). SApwMS were treated with DMT earlier than AApwMS (HR 2.16, p = 0.012) and WApwMS (HR 1.86, p = 0.041). SApwMS were less commonly treated with natalizumab (SApwMS 0 %, AApwMS 13 %, WApwMS 25 %; p = 0.035) and anti-CD20 therapies (SApwMS 23 %, AApwMS 23 %, WApwMS 48 %; p = 0.005). PMS occurred in 3/19 SApwMS, 28/92 AApwMS and 29/94 WApwMS (p > 0.05). Age of PMS onset in SApwMS (47 years, 34-57) was similar to WApwMS (47 years, 31-71; p > 0.05) but older than AApwMS (41 years, 18-7; p = 0.008).
CONCLUSIONS
SApwMS that recently immigrated to the USA have similar disease course to WApwMS, and better than AApwMS from the same geographical region.
背景
白人和黑人群体之间的多发性硬化（MS）病程差异已得到广泛认可。明尼苏达州有大量索马里移民，这为研究该移民原生非洲人群中的 MS 特征提供了便利。本研究的目的是比较索马里裔美国人（SA）、非裔美国人（AA）和白人美国人（WA）多发性硬化症患者（pwMS）的临床特征和疾病修正治疗（DMT）使用情况。
方法
这项单中心（梅奥诊所）的地域限制回顾性队列研究（居住在美国明尼苏达州罗切斯特市 250 英里范围内）纳入了 2023 年 5 月前就诊的参与者。移民到美国的年龄；MS 发病年龄；DMT 使用/类型；MS 阶段/表型；进行性 MS（PMS）发病年龄；以及严重 MS（扩展残疾状况量表-EDSS≥6）的比例。
结果
纳入了 18 名 SApwMS、92 名 AApwMS 和 94 名 WApwMS。在未出生于美国的 15 名 SApwMS 中，有 3/15 是在青春期前移民的，有 3/15 是在青春期移民的，有 8/15 是在青春期后移民的，有 1/15 是在未知日期移民的。SApwMS 的 MS 发病年龄更年轻（中位数年龄，四分位距（IQR）=25，22-33 岁 vs. AApwMS：31，25-38 岁；p=0.049 vs. WApwMS：35，27-41 岁；p=0.022）。DMT 使用频率为 19 名 SApwMS 中有 13 名、92 名 AApwMS 中有 69 名、94 名 WApwMS 中有 80 名（p>0.05）。SApwMS 比 AApwMS（HR 2.16，p=0.012）和 WApwMS（HR 1.86，p=0.041）更早开始接受 DMT 治疗。SApwMS 较少接受那他珠单抗（SApwMS 0%，AApwMS 13%，WApwMS 25%；p=0.035）和抗 CD20 治疗（SApwMS 23%，AApwMS 23%，WApwMS 48%；p=0.005）。3/19 名 SApwMS、28/92 名 AApwMS 和 29/94 名 WApwMS 发生了 PMS（p>0.05）。SApwMS 的 PMS 发病年龄为 47 岁（34-57 岁），与 WApwMS 相似（47 岁，31-71 岁；p>0.05），但比 AApwMS 年长（41 岁，18-7 岁；p=0.008）。
结论
最近移民到美国的 SApwMS 的病程与 WApwMS 相似，优于来自同一地理区域的 AApwMS。
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