Kurtzke J F, Delasnerie-Lauprêtre N, Wallin M T
Neuroepidemiology Research Program, Veterans Affairs Medical Center, Washington, DC 20422, USA.
Acta Neurol Scand. 1998 Nov;98(5):302-9. doi: 10.1111/j.1600-0404.1998.tb01738.x.
Among some 7500 respondents with known place of birth who had completed a nationwide questionnaire survey for multiple sclerosis (MS) in France in 1986, there were 260 born in former French North Africa (Algeria, Morocco, Tunisia). They had migrated to France between 1923 and 1986, but 66% came between 1956 and 1964. Two-thirds were from Algeria, where virtually the entire European population had emigrated in 1962 at the end of the Algerian war for independence. The migrants were younger at prevalence day (mean 43.4 years) and at onset (29.4 years) than the French-born MS (46.6; 31.3 years). Eight migrants lacked age information. The 225 migrants with onset more than 1 year after immigration presumably acquired their MS in France. They provided an age adjusted (US 1960) MS prevalence rate 1.54 times that for all France. If the latter is taken at 50 per 100,000 population their estimated adjusted rate is 76.8 with 95% confidence interval of 67.1 to 87.5. The other 27 with presumed acquisition in North Africa gave an estimated adjusted prevalence of 16.6 per 100,000 (95% CI 10.9-24.1). For those migrants with acquisition in France there was a mean interval of 13 years between immigration or age 11 and clinical onset, with a minimum of 3 years. This series provides further support for the theses: 1) that MS is primarily an environmental disease acquired after childhood; 2) that acquisition requires prolonged or repeated exposure (here 3 years for these medium-to-high MS risk migrants) followed by a prolonged latent or incubation period between acquisition and symptom onset (here 10 years); and 3) that this disease is most likely a widespread but unknown persistent infection which results in clinical MS in only a small proportion of those affected.
在1986年法国一项针对多发性硬化症（MS）的全国性问卷调查中，约7500名已知出生地的受访者中，有260人出生于法属北非地区（阿尔及利亚、摩洛哥、突尼斯）。他们于1923年至1986年间移民至法国，但66%的人是在1956年至1964年间抵达法国的。其中三分之二来自阿尔及利亚，在阿尔及利亚独立战争结束的1962年，该国几乎所有欧洲人口都已移民。这些移民在患病时（平均43.4岁）和发病时（29.4岁）比在法国出生的MS患者（46.6岁；31.3岁）更年轻。有8名移民缺少年龄信息。225名在移民1年多后发病的移民，其MS可能是在法国患上的。他们经年龄调整（采用美国1960年标准）后的MS患病率是全法国的1.54倍。若全法国的患病率按每10万人50例计算，那么他们经调整后的估计患病率为76.8例，95%置信区间为67.1至87.5。另外27名推测在北非患病的移民，其经调整后的估计患病率为每10万人16.6例（95%置信区间10.9 - 24.1）。对于那些在法国患病的移民，从移民或11岁起至临床发病的平均间隔时间为13年，最短为3年。该系列研究进一步支持了以下论点：1）MS主要是一种儿童期后获得的环境性疾病；2）患病需要长期或反复接触（对于这些中高MS风险移民来说是3年），随后在接触与症状出现之间有一段长潜伏期或孵育期（这里是10年）；3）这种疾病很可能是一种广泛存在但未知的持续性感染，仅在一小部分感染者中引发临床MS。
