THE EPIDEMIOLOGY OF MULTIPLE-SCLEROSIS - A GENERAL OVERVIEW
THE EPIDEMIOLOGY OF MULTIPLE-SCLEROSIS - A GENERAL OVERVIEW
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DOI：
10.1002/ana.410360805
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发表时间：
1994-12-01
影响因子：
11.2
通讯作者：
POSER, CM
中科院分区：
文献类型：
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作者：
POSER, CM
多发性硬化症(MS)的流行病学研究已经表明遗传易感因素的重要性，这些因素被未知的环境影响所改变。经常被引用的流行率和纬度之间的相互关系已经不再可行，澳大利亚和新西兰是一个重要但无法解释的例外。统一诊断标准的标准化和越来越多的使用为MS调查结果提供了新的可信度。对于疾病的首发症状、设备综合征和进展性疾病，提供了更精确的标准。本文综述了磁共振成像在多发性硬化症诊断中的作用，以及其滥用的缺陷。多发性硬化症流行的报告被检查和丢弃，因为它们是基于生物学上没有意义的诊断日期或发病日期，而不是可能获得多发性硬化症的时间，即青春期之前。发病调整患病率的概念表明，有症状的患者应该包括在流行病学调查中，甚至在他们被正式诊断为患有多发性硬化症之前就应该包括在内，但在转移到研究地区之前有症状的人不应该包括在内。在流行率和危险因素研究中，患者和对照对象的种族同质性的重要性怎么强调都不为过。在后一种情况下，必须密切注意生物学上的似是而非和谨慎的统计解释。多发性硬化症特征的假说描述了一种不影响神经系统的全身性、无症状的情况，并可能解释为什么同卵双胞胎的疾病一致性较低。
Epidemiological studies of multiple sclerosis (MS) have shown the importance of genetic susceptibility factors that are modified by as yet unknown environmental influences. The often-cited interrelation between prevalence and latitude is no longer viable, with the important but unexplained exception of Australia and New Zealand. The standardization and increasing use of uniform diagnostic criteria lend new credibility to the results of MS surveys. More precise criteria are offered for symptoms of disease onset, Devic's syndrome, and progressive disease. The role of magnetic resonance imaging in the diagnosis of MS, and the pitfalls of its abuse, are reviewed. Reports of epidemics of MS are examined and discarded because they are based on the biologically meaningless date of diagnosis or that of onset, rather than when MS was probably acquired, that is, before puberty. The concept of onset-adjusted prevalence suggests that patients who are symptomatic should be included retrospectively in epidemiological surveys, even before they have been formally diagnosed ai having MS, but individuals who were symptomatic before moving to a study area should not. The importance of ethnic homogeneity of patients and control subjects cannot be overemphasized in prevalence and risk factor studies. In the latter, close attention must be paid to biological plausibility and to prudent statistical interpretation. The hypothesis of the MS trait describes a systemic, asymptomatic condition that does not affect the nervous system, and may explain the low concordance of the disease in monozygotic twins.