Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis
Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis
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DOI：
10.1212/wnl.0b013e3181d6b125
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发表时间：
2010-03-30
期刊：
影响因子：
9.9
通讯作者：
Vollmer, T.
中科院分区：
文献类型：
--
作者：
Marrie, R. A.;Rudick, R.;Vollmer, T.
背景：血管合并症对几种慢性疾病的健康结果有不利影响。血管合并症在多发性硬化（MS）中很常见，但其对疾病严重程度的影响尚不清楚。血管合并症可能导致MS疾病严重程度的异质性知之甚少。血管合并症的治疗可能是治疗MS的一种途径。方法：共有8,983例MS患者参加了北美多发性硬化症研究委员会的登记研究。比较有或没有血管合并症的患者从症状发作或诊断到行走障碍的时间，以确定其对MS严重程度的影响。多变量比例风险模型根据性别、种族、症状发作时的年龄、症状发作的年份、社会经济状况和居住地区进行调整。结果：在诊断时报告一种或多种血管合并症的参与者的行走残疾风险增加，并且风险随着报告血管疾病的数量增加而增加（早期步态残疾的风险比[HR]/状况1.51; 95%置信区间[CI] 1.41-1.61）。病程中任何时间的血管合并症也增加了行走障碍的风险（单侧行走辅助的校正HR为1.54; 95% CI为1.44-1.65）。诊断和需要门诊援助之间的中位时间为18.8年的患者没有和12.8年的患者血管comorbidity.Conclusions：血管合并症，无论是在症状发作，诊断，或在病程后期，与多发性硬化症的残疾进展的风险大大增加。治疗血管合并症对疾病进展的影响值得研究。神经病学（R）2010;74：1041-1047
Background: Vascular comorbidity adversely influences health outcomes in several chronic conditions. Vascular comorbidities are common in multiple sclerosis (MS), but their impact on disease severity is unknown. Vascular comorbidities may contribute to the poorly understood heterogeneity in MS disease severity. Treatment of vascular comorbidities may represent an avenue for treating MS.Methods: A total of 8,983 patients with MS enrolled in the North American Research Committee on Multiple Sclerosis Registry participated in this cohort study. Time from symptom onset or diagnosis until ambulatory disability was compared for patients with or without vascular comorbidities to determine their impact on MS severity. Multivariable proportional hazards models were adjusted for sex, race, age at symptom onset, year of symptom onset, socioeconomic status, and region of residence.Results: Participants reporting one or more vascular comorbidities at diagnosis had an increased risk of ambulatory disability, and risk increased with the number of vascular conditions reported (hazard ratio [HR]/condition for early gait disability 1.51; 95% confidence interval [CI] 1.41-1.61). Vascular comorbidity at any time during the disease course also increased the risk of ambulatory disability (adjusted HR for unilateral walking assistance 1.54; 95% CI 1.44-1.65). The median time between diagnosis and need for ambulatory assistance was 18.8 years in patients without and 12.8 years in patients with vascular comorbidities.Conclusions: Vascular comorbidity, whether present at symptom onset, diagnosis, or later in the disease course, is associated with a substantially increased risk of disability progression in multiple sclerosis. The impact of treating vascular comorbidities on disease progression deserves investigation. Neurology (R) 2010;74:1041-1047