Increased Risk of Multiple Sclerosis after Traumatic Brain Injury: A Nationwide Population-Based Study
Increased Risk of Multiple Sclerosis after Traumatic Brain Injury: A Nationwide Population-Based Study
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DOI：
10.1089/neu.2011.1936
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发表时间：
2012-01-01
影响因子：
4.2
通讯作者：
Lin, Herng-Ching
中科院分区：
文献类型：
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作者：
Kang, Jiunn-Horng;Lin, Herng-Ching
多发性硬化症（MS）的病因尚不清楚。先前的数据显示，关于多发性硬化症与先前脑外伤之间的关系，结果相互矛盾。本研究旨在采用大规模队列研究设计调查创伤性脑损伤（TBI）后多发性硬化症的风险。这项研究使用了来自国家健康保险研究数据库的数据。共有72,765例TBI患者被确定并纳入研究队列，随机选择218,295名受试者按性别和年龄与研究队列相匹配作为对照。我们对每位患者进行了为期6年的追踪，从他们的指数医疗保健利用情况开始，以确定那些随后被诊断为多发性硬化症的患者。我们使用Kaplan-Meier方法和log-rank检验来比较两组患者6年无多发性硬化症生存率的差异。计算分层Cox比例风险回归来比较这两个队列发生多发性硬化症的风险。TBI患者在6年期间MS的发生率高于对照组（0.055%对0.037%）。在排除了非多发性硬化症死亡病例，将住院病例作为严重程度的代理进行分层，并根据患者所在社区的月收入和地理区域进行调整后，住院治疗的TBI损伤患者的多发性硬化症风险比（HR）为1.97 (95% CI 1.31,2.93, p
The etiology of multiple sclerosis (MS) is still not well known. Previous data show conflicting results regarding the association between MS and prior brain trauma. This study aims to investigate the risk for MS following a traumatic brain injury (TBI) using a large-scale cohort study design. This study used data from the National Health Insurance Research Database. A total of 72,765 patients with TBI were identified and included as the study cohort, and 218,295 randomly selected subjects were matched with the study cohort by sex and age as controls. We traced each patient individually for a 6-year period from their index health care utilization to identify those who received a subsequent diagnosis of MS. We used the Kaplan-Meier method and the log-rank test to compare the difference in 6-year MS-free survival rates between the two groups. Stratified Cox proportional hazard regressions were computed to compare the risk of developing MS for these two cohorts. Patients with TBI had a higher incidence of MS during the 6-year period than the comparison group (0.055% versus 0.037%). After excluding cases who died from non-MS causes, stratifying for hospitalization of cases as a proxy for severity, and adjusting for monthly income and geographic region of the community in which the patient resided, the hazard ratio (HR) of MS for patients with hospital-treated TBI injuries was 1.97 (95% CI 1.31,2.93, p