Five years before multiple sclerosis onset: Phenotyping the prodrome
Five years before multiple sclerosis onset: Phenotyping the prodrome
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DOI：
10.1177/1352458518783662
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发表时间：
2019-07-01
影响因子：
5.8
通讯作者：
Tremlett, Helen
中科院分区：
文献类型：
--
作者：
Wijnands, Jose M. A.;Zhu, Feng;Tremlett, Helen
背景：多发性硬化症 (MS) 前驱症状的特征尚不清楚。目的：通过医疗保健经历对多发性硬化症前驱症状进行表型分析。方法：利用一项基于人群的队列研究，将加拿大四个省的行政和临床数据联系起来，我们将多发性硬化症受试者在行政队列中首次脱髓鞘索赔或多发性硬化症诊所衍生队列中临床症状发作前 5 年内的医生和医院就诊情况以及处方（通过国际疾病分类章节、医生专业或药物类别）与年龄、性别和地理匹配的对照进行比较。估计了比率 (RR)、95% 置信区间 (95% CI) 和比例。结果：管理和临床队列包括 13,951/66,940 和 3202/16,006 例患有和不患有 MS 的患者（病例/对照）。与对照组相比，在首次脱髓鞘症状或症状出现前的 5 年内，病例因神经（RR（范围）= 2.31；95% CI：1.05-5.10 至 4.75；95% CI：3.11-7.25）、感觉（RR（范围）= 1.40；95% CI：1.34-1.46）而有更多的医生和医院就诊次数 to 2.28; 95% CI: 1.72-3.02), musculoskeletal (RR (range) = 1.19; 95% CI: 1.07-1.33 to 1.70; 95% CI: 1.57-1.85) and genito-urinary systems (RR (range) = 1.17; 95% CI: 1.05-1.30 to 1.59; 95% CI: 1.48-1.70). Cases had more psychiatrist and urologist encounters (RR (range) = 1.48; 95% CI: 1.36-1.62 to 1.80; 95% CI: 1.61-2.01), and higher proportions of musculoskeletal, genito-urinary or hormonal-related prescriptions (1.1-1.5 times higher, all p < 0.02）。然而，病例中与妊娠相关的事件比对照组少（RR = 0.78；95% CI：0.71-0.86 至 0.88；95% CI：0.84-0.92）。结论：在临床识别 MS 之前 5 年对前驱症状进行表型分型是可行的。
Background: The multiple sclerosis (MS) prodrome is poorly characterized. Objective: To phenotype the MS prodrome via health care encounters. Methods: Using data from a population-based cohort study linking administrative and clinical data in four Canadian provinces, we compared physician and hospital encounters and prescriptions filled (via International Classification of Diseases chapters, physician specialty or drug classes) for MS subjects in the 5 years before the first demyelinating claim in an administrative cohort or the clinical symptom onset in an MS clinic-derived cohort, to age-, sex- and geographically matched controls. Rate ratios (RRs), 95% confidence intervals (95% CIs) and proportions were estimated. Results: The administrative and clinical cohorts included 13,951/66,940 and 3202/16,006 people with and without MS (cases/controls). Compared to controls, in the 5 years before the first demyelinating claim or symptom onset, cases had more physician and hospital encounters for the nervous (RR (range) = 2.31; 95% CI: 1.05-5.10 to 4.75; 95% CI: 3.11-7.25), sensory (RR (range) = 1.40; 95% CI: 1.34-1.46 to 2.28; 95% CI: 1.72-3.02), musculoskeletal (RR (range) = 1.19; 95% CI: 1.07-1.33 to 1.70; 95% CI: 1.57-1.85) and genito-urinary systems (RR (range) = 1.17; 95% CI: 1.05-1.30 to 1.59; 95% CI: 1.48-1.70). Cases had more psychiatrist and urologist encounters (RR (range) = 1.48; 95% CI: 1.36-1.62 to 1.80; 95% CI: 1.61-2.01), and higher proportions of musculoskeletal, genito-urinary or hormonal-related prescriptions (1.1-1.5 times higher, all p < 0.02). However, cases had fewer pregnancy-related encounters than controls (RR = 0.78; 95% CI: 0.71-0.86 to 0.88; 95% CI: 0.84-0.92). Conclusion: Phenotyping the prodrome 5 years before clinical recognition of MS is feasible.