Prodrome in relapsing-remitting and primary progressive multiple sclerosis
Prodrome in relapsing-remitting and primary progressive multiple sclerosis
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DOI：
10.1111/ene.13925
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发表时间：
2019-07-01
影响因子：
5.1
通讯作者：
Tremlett, H.
中科院分区：
文献类型：
--
作者：
Wijnands, J. M. A.;Zhu, F.;Tremlett, H.
背景和目的多发性硬化症的前驱症状仍然知之甚少。我们的目的是研究复发缓解型多发性硬化症(RMS)和原发进行性多发性硬化症(PPMS)患者的前驱症状。方法我们利用加拿大两个省的临床和相关卫生管理数据进行了一项匹配的队列研究。我们确定了患有RMS、PPMS和年龄、性别和地理匹配的人口控制的人，并比较了症状出现前五年内的医生就诊次数(根据国际疾病分类章节和每个医生专业)。调整了性别、年龄、社会经济地位和历年的负二项回归模型。结果我们确定了1887例RMS，171例PPMS病例和9837例匹配的人群对照。在RMS和PPMS之间，或者在表型和各自的对照之间，在指数之前的五年中，总的相遇次数没有差异。与RMS病例相比，PPMS患者与神经系统相关的接触更多(调整后的比率为3.00；95%可信区间为1.06-8.49)，与皮肤科医生的接触更少(调整后的比率比率为0.53；95%可信区间为0.30-0.96)。结论研究结果表明，RMS和PPMS患者都可能经历先兆，尽管方面可能不同。
Background and purpose The multiple sclerosis prodrome remains poorly understood. We aimed to examine the prodrome in people with relapsing remitting multiple sclerosis at onset (RMS) and primary progressive multiple sclerosis (PPMS). Methods We conducted a matched cohort study using clinical and linked health administrative data in two Canadian provinces. We identified people with RMS, PPMS and age- sex- and geographically-matched population controls, and compared the number of physician encounters (total number, per International Classification of Diseases chapter, and per physician speciality) in the five years before symptom onset. Negative binomial regression models were sex, age, socioeconomic status and calendar year adjusted. Results We identified 1887 RMS, 171 PPMS cases, and 9837 matched population controls. No difference existed in the total number of encounters in the five years before index between RMS and PPMS, or between the phenotypes and their respective controls. Compared to RMS cases, PPMS cases had more nervous system-related encounters (adjusted rate ratio, 3.00; 95% confidence interval, 1.06-8.49) and fewer encounters with dermatologists (adjusted rate ratio 0.53; 95% confidence interval, 0.30-0.96). Conclusion Findings suggest that people with RMS and PPMS may both experience a prodrome, although aspects may differ.