Natural history of human T-lymphotropic virus 1-associated myelopathy -: A 14-year follow-up study
Natural history of human T-lymphotropic virus 1-associated myelopathy -: A 14-year follow-up study
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DOI：
10.1001/archneur.63.11.1560
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发表时间：
2006-11-01
影响因子：
--
通讯作者：
Smadja, Didier
中科院分区：
文献类型：
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作者：
Olindo, Stephane;Cabre, Philippe;Smadja, Didier
背景资料：人类嗜T淋巴细胞病毒1型（HTLV-1）相关性脊髓病/热带痉挛性轻瘫（HAM/TSP）的神经功能障碍进展尚未明确。目的：确定HAM/TSP患者的残疾评分的时间进程，并确定预后的预测因素。设计：临床14年随访研究。地点：大学医院。患者：123例HAM/TSP患者。主要预后指标：我们确定了从发病到以下4个Kurtzke残疾状态量表（DSS）终点的时间：6分（需要单侧帮助），6.5分（需要双侧帮助），8分（轮椅限制）和10分（疾病相关死亡）。使用Kaplan-Meier方法估计达到选定DSS评分的时间。单变量和多变量分析确定了与进展至DSS 8的速率相关的变量。HTLV-1前病毒的负荷也assessed.Results：残疾的队列进展整个随访期间。从发病到DSS 6、6.5和8的中位时间分别为6、13和21年。从DSS 6到DSS 8的中位时间为8年;四分之一的患者在20年内达到DSS 10。发病年龄≥ 50岁和高HTLV-1前病毒载量与DSS 8的时间较短相关（分别为P = .01和P = .02）。较短的DSS 6的时间显着不利影响的时间从DSS 6到DSS 8的进展。结论：人类T淋巴细胞病毒1相关性脊髓病/热带痉挛性下肢轻瘫是一种快速致残性疾病。建议在未来的治疗试验中监测HTLV-1前病毒载量。
Background: The progression of neurological disability in human T-lymphotropic virus 1 (HTLV-1)associated myelopathy/tropical spastic paraparesis (HAM/TSP) remains undefined.Objectives: To determine the time course of disability scores and to identify predictors of outcome among patients with HAM/TSP.Design: Clinical 14-year follow-up study.Setting: University hospital.Patients: One hundred twenty-three patients with HAM/TSP.Main Outcome Measures: We determined time from onset to the following 4 Kurtzke Disability Status Scale (DSS) end points: scores of 6 (unilateral aid required), 6.5 (bilateral aid required), 8 (wheelchair confinement), and 10 (death related to the disease). Times to reach selected DSS scores were estimated using the Kaplan-Meier method. Univariate and multivariate analyses identified variables related to the rate of progression to DSS 8. The HTLV-1 proviral loads were also assessed.Results: The disability of the cohort progressed throughout the follow-up period. The median times from onset to DSS 6, 6.5, and 8 were 6, 13, and 21 years, respectively. The median time from DSS 6 to DSS 8 was 8 years; DSS 10 was reached by one fourth of the patients within 20 years. Age at onset of 50 years or older and high HTLV-1 proviral load were associated with a shorter time to DSS 8 (P = .01 and P = .02, respectively). A shorter time to DSS 6 significantly adversely affected the time to progression from DSS 6 to DSS 8.Conclusions: Human T-lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis is a rapidly disabling disease. Monitoring for HTLV-1 proviral load is recommended in future therapeutic trials.