Comorbidity increases the risk of relapse in multiple sclerosis A prospective study
Comorbidity increases the risk of relapse in multiple sclerosis A prospective study
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DOI：
10.1212/wnl.0000000000004716
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发表时间：
2017-12-12
期刊：
影响因子：
9.9
通讯作者：
Marrie, Ruth Ann
中科院分区：
文献类型：
--
作者：
Kowalec, Kaarina;McKay, Kyla A.;Marrie, Ruth Ann
目的：为了评估合并症和复发率之间的关联在个人多发性硬化症（MS）。方法：我们招募个人与流行的复发发作MS从4加拿大MS诊所参加一项为期2年的前瞻性多中心队列研究，涉及横截面评估合并症和复发。使用问卷记录合并症，并在每次访视时从医疗记录中捕获复发。在随后的2年随访期间，使用Poisson回归，调整年龄，性别，残疾，疾病持续时间和治疗status.Results：在885名参与者中，678（76.6%）是女性，平均年龄48.2岁的基线共病和复发率之间的关联进行了检查。焦虑（40.2%）、抑郁（21.1%）、高血压（17.7%）、偏头痛（18.1%）和高脂血症（11.9%）是最常见的合并症。在基线后第1年和第2年，受试者复发的频率保持不变，分别为14.9%和13.2%。调整后，报告≥ 3种基线合并症（相对于无）的参与者在随后的2年内复发率较高（调整率比1.45，95%置信区间[CI] 1.00-2.08）。偏头痛和高脂血症与复发率增加相关（校正率比1.38; 95%CI分别为1.01-1.89和1.67; 95%CI为1.07-2.61）。结论：偏头痛、高脂血症或高合并症负担（3种或3种以上）患者2年以上复发率增加。这些发现对于理解MS复发的病理生理学具有潜在意义，并表明可能需要对具有特定或多种合并症的个体进行更密切的监测。未来的研究需要了解合并症的存在是否需要量身定制的MS管理方法。
Objective: To evaluate the association between comorbidity and relapse rate in individuals with multiple sclerosis (MS).Methods: We recruited individuals with prevalent relapsing-onset MS from 4 Canadian MS Clinics to participate in a 2-year prospective multicenter cohort study involving cross-sectional assessment of comorbidities and relapses. Comorbidities were recorded using questionnaires, and relapses were captured from medical records at each visit. The association between comorbidities at baseline and relapse rate over the subsequent 2-year follow-up period was examined using Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status.Results: Of 885 participants, 678 (76.6%) were women, averaging age 48.2 years at baseline. Anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%), and hyperlipidemia (11.9%) were the most prevalent comorbidities. The frequency of participants experiencing relapses remained constant at 14.9% and 13.2% in years 1 and 2 post-baseline. After adjustment, participants reporting >= 3 baseline comorbidities (relative to none) had a higher relapse rate over the subsequent 2 years (adjusted rate ratio 1.45, 95% confidence interval [CI] 1.00-2.08). Migraine and hyperlipidemia were associated with increased relapse rate (adjusted rate ratio 1.38; 95% CI 1.01-1.89 and 1.67; 95% CI 1.07-2.61, respectively).Conclusions: Individuals with migraine, hyperlipidemia, or a high comorbidity burden (3 or more conditions) had an increased relapse rate over 2 years. These findings have potential implications for understanding the pathophysiology of MS relapses, and suggest that closer monitoring of individuals with specific or multiple comorbidities may be needed. Future research is needed to understand if the presence of comorbidity warrants a tailored approach to MS management.