Offspring number, pregnancy, and risk of a first clinical demyelinating event The AusImmune Study
Offspring number, pregnancy, and risk of a first clinical demyelinating event The AusImmune Study
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DOI：
10.1212/wnl.0b013e31824c4648
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发表时间：
2012-03-01
期刊：
影响因子：
9.9
通讯作者：
Dwyer, T.
中科院分区：
文献类型：
--
作者：
Ponsonby, A. -L.;Lucas, R. M.;Dwyer, T.
目的：检查过去怀孕，后代数量，和第一次临床脱髓鞘risk.Methods：病例（n = 282）年龄为18-59岁，第一次临床诊断中枢神经系统脱髓鞘（第一次临床脱髓鞘事件[FCD]）和居民在1个4澳大利亚中心（从南纬27度到43度）从2003年至2006年。对照组（n = 542）与年龄、性别和研究区域的病例相匹配，没有CNS脱髓鞘的首次临床诊断。结果：女性（p < 0.001）而非男性（p = 0.71）的后代数量与FCD风险相关;效果差异; p = 0.001。在女性中，较高的产次与FCD风险降低相关（每次出生的校正比值比为0.51 [95%置信区间为0.36，0.72]），在经典首次脱髓鞘事件中观察到类似程度的影响（校正比值比为0.47 [95%置信区间为0.29，0.74]）。仅在经产妇女中，较高产次的明显有益效果也很明显（p < 0.001）。在这些病例中，对于那些后代数量低但不高（4个或更多）的病例，明显存在雌性过剩。人类白细胞抗原DR 15基因型等因素似乎并没有改变更高的产次和FCD风险降低之间的关联在women.Conclusions：这些发现是一致的累积有益的影响怀孕。随着时间的推移，随着年龄的增长，产妇分娩年龄的增加和后代数量的减少可能是MS病例中女性过剩的部分原因。神经病学（R）2012;78：867-874
Objective: To examine the association between past pregnancy, offspring number, and first clinical demyelination risk.Methods: Cases (n = 282) were aged 18-59 years with a first clinical diagnosis of CNS demyelination (first clinical demyelinating event [FCD]) and resident within 1 of 4 Australian centers (from latitudes 27 degrees south to 43 degrees south) from 2003 to 2006. Controls (n = 542) were matched to cases on age, sex, and study region, without first clinical diagnosis of CNS demyelination.Results: Higher offspring number was associated with FCD risk among women (p < 0.001) but not men (p = 0.71); difference in effect; p = 0.001. Among women, higher parity was associated with reduced risk of FCD (adjusted odds ratio 0.51 [95% confidence interval 0.36, 0.72] per birth) with a similar magnitude of effect observed among classic first demyelinating events (adjusted odds ratio 0.47 [95% confidence interval 0.29, 0.74]). The apparent beneficial effect of higher parity was also evident among parous women only (p < 0.001). Among cases, a clear female excess was evident for those with low but not high (4 or more) offspring number. Factors such as human leukocyte antigen DR15 genotype did not appear to modify the association between higher parity and a reduced FCD risk among women.Conclusions: These findings are consistent with a cumulative beneficial effect of pregnancy. Temporal changes toward an older maternal age of parturition and reduced offspring number may partly underlie the increasing female excess among MS cases over time. Neurology (R) 2012;78:867-874