Heat Exposure and Multiple Sclerosis-A Regional and Temporal Analysis.
Heat Exposure and Multiple Sclerosis-A Regional and Temporal Analysis.
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DOI：
10.3390/ijerph18115962
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发表时间：
2021-06-02
影响因子：
--
通讯作者：
Kumar N
中科院分区：
文献类型：
--
作者：
Chacko G;Patel S;Galor A;Kumar N
多发性硬化症(MS)是一种神经系统疾病，会逐渐扭曲中枢神经系统(CNS)内轴突的髓鞘形成。运动导致的核心体温或新陈代谢增加是多发性硬化症患者神经症状短期恶化的常见原因。大约60%-80%的多发性硬化症患者在接触高温时症状恶化。相比之下，关于环境气象条件(例如，温度和相对湿度)与这些变量的波动与MS症状之间的关系的数据较少。因此，这项研究调查了2010至2013年间美国退伍军人中暴露在气象条件下的时间滞后与多发性硬化症就诊风险之间的关系。这项研究利用了退伍军人事务部(VA)和国家气候数据中心(NCDC)为美国大陆划分的八个气候带的数据。我们使用病例交叉设计来评估与几种气象条件有关的多发性硬化症诊所就诊的风险。计算了每个病例(即MS就诊日)和对照组(就诊前随机分配的日期±90-270天)每天(环境)暴露于温度、相对湿度和温度变化(温度的标准差(SD))的特定地点的时间滞后。进行了统计分析，以检查选定的气象条件与国家和区域一级多发性硬化症就诊风险之间的独立联系。共有533,066名患者被诊断为多发性硬化症(国际疾病分类(ICD)-9代码=340)。东北和上中西部地区报告的就诊频率最高，春季、夏季和秋季(3-10月)就诊的可能性比冬季高9%(OR=1.089；95%CI=1.076-1.103；p<；0.01)。在单变量分析中，温度、温度和温度-相对湿度相互作用的标准差与多发性硬化症就诊风险增加正相关，而相对湿度与就诊风险负相关。在多变量分析中，多发性硬化症的就诊次数与体温的标准差有最强的相关性(OR=1.012；95%可信区间1.008-1.017；p<；0.01)。多发性硬化症诊所就诊和气象条件之间的关联因气候区域而异，最强的关联出现在低兆瓦、超重型、大南威尔士州和东北地区。当对区域进行检查时，温度的SD再次成为最强的相关预测因子。温度变化和温度-相对湿度的相互作用(热度指数的替代指标)显示出与多发性硬化症诊所就诊显著相关。当从地理上考察时，这些关联在不同的气候地区有所不同。我们的发现对重症或复发病例的多发性硬化症的治疗有一定的指导意义，特别是考虑到随着全球变暖的加剧，预计每天的温度变化和热浪强度即将发生变化。
Multiple sclerosis (MS) is a neurological disorder that progressively distorts the myelination of axons within the central nervous system (CNS). Increased core body temperature or metabolism as a result of exercise are common causes of short-term exacerbations of neurological symptoms in MS. About 60–80% of patients with MS experience a worsening of their symptoms when exposed to heat. In comparison, less data are available on the relationship between ambient meteorological conditions (e.g., temperature and relative humidity (RH)) and fluctuations in such variables in relation to MS symptoms. Thus, this study examined associations between time-lagged exposure to meteorological conditions and risk of a clinic visit due to MS among US veterans between 2010 and 2013. This study leveraged data from the Veterans Affairs (VA) and National Climactic Data Center (NCDC) for the continental US, partitioned into eight climate zones. We used a case crossover design to assess the risk of a MS clinic visit with respect to several meteorological conditions. Location-specific time-lagged daily (ambient) exposure to temperature, RH, and temperature variations (standard deviation (SD) of temperature) were computed (up to 30 days) for each case (i.e., day of MS visit) and control (a randomly assigned date ± 90–270 days prior to visit). Statistical analyses were conducted to examine independent associations between the selected meteorological conditions and risk of MS visits at the national and regional levels. A total of 533,066 patient visits received a MS diagnosis (International Classifications of Diseases (ICD)-9 code = 340). The Northeast (NE) and Upper Midwest (UMW) regions reported the highest frequency of clinic visits due to MS. Clinic visits were 9% more likely to occur in the spring, summer, and fall months (March–October) than in the winter (OR = 1.089; 95% CI = 1.076–1.103; p < 0.01). In the univariate analyses, the SD of temperature, temperature, and temperature–RH interaction were positively associated with an elevated risk of a MS clinic visit, while the RH was negatively associated with the risk for a clinic visit. In multivariate analyses, the strongest association of a MS clinic visit was observed with the SD of the temperature (OR = 1.012; 95% CI 1.008–1.017; p < 0.01). These associations between MS clinic visits and meteorological conditions varied across climate regions, with the strongest associations being observed in the LMW, UMW, DSW, and NE zones. The SD of the temperature was again the strongest associated predictor when examined regionally. Temperature variations and temperature–RH interactions (a proxy of the heat index) showed significant associations with MS clinic visits. These associations varied across climate regions when examined geographically. Our findings have implications for the management of MS in severe or recurrent cases, especially considering the impending changes in the daily temperature variations and intensity of the heatwaves expected with the intensification of global warming.
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DOI：
10.1001/archneurpsyc.1955.02330140087015
发表时间：
1955-01-01
影响因子：
--
作者：
HOPKINS, CE;SWANK, RL
通讯作者：
SWANK, RL
影响因子：
9.8
作者：
Qiu, Hong;Yu, Ignatius Tak-sun;Tian, Linwei
通讯作者：
Tian, Linwei
影响因子：
14.6
作者：
Kenny, Glen P.;Yardley, Jane;Jay, Ollie
通讯作者：
Jay, Ollie
影响因子：
5.2
作者：
KARL, TR;KUKLA, G;FU, CB
通讯作者：
FU, CB
影响因子：
5.2
作者：
Li, K.;Ni, H.;Su, H.
通讯作者：
Su, H.