复发缓解型多发性硬化复发风险与血清生化指标的关联

Association between relapse risk in relapsing-remitting multiple sclerosis and serum biochemical indicators

目的通过分析复发缓解型多发性硬化(RRMS)首次发作时血清生化指标与复发之间的关联,探究RRMS患者复发风险的影响因素,为RRMS的治疗和管理提供依据。方法收集2012年1月-2020年12月中山大学附属第三医院神经内科收治的首次确诊RRMS患者,收集患者年龄、性别、疾病诊断分型与首次发作时血清生化检查的基线信息和扩展残疾状态量表(EDSS)评分、治疗措施与疾病复发的随访信息。采用Anderson and Gill(AG)比例风险模型探究RRMS复发风险的影响因素。结果共纳入127例患者,其中男性40例,女性87例,中位年龄为27.0(22.0,34.5)岁,年复发率为44.2%(25.4%,65.4%)。综合AG模型单因素和多因素回归分析结果,发现首次发作时天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及磷酸肌酸激酶同工酶(CK-MB)水平与RRMS复发风险存在关联,每变化5个单位的HR值分别为1.15(95%CI:1.06~1.26)、1.10(95%CI:1.06~1.15)、1.40(95%CI:1.01~1.95),差异均有统计学意义(P均<0.05)。结论在首次确诊的RRMS患者血清中,AST、ALT和CK-MB水平的升高与复发风险增加有关,可为临床医师制定治疗方案提供参考依据,减少复发的发生。

Objective To explore the influencing factors of relapse risk in relapsing-remitting multiple sclerosis(RRMS)patients by analyzing the relationship between serum biochemical indicators at the first attack of RRMS and relapse,and to provide evidence for the treatment and management of RRMS.Methods From January 2012 to December 2020,patients with first-diagnosed RRMS who were admitted to the Department of Neurology,the Third Affiliated Hospital of Sun Yat-sen University were collected.The age,sex,disease diagnosis type,baseline information of serum biochemical examination at the first attack and expanded disability status scale(EDSS)scores,treatment measures,and follow-up information on disease recurrence were collected and analyzed.Anderson and Gill(AG)proportional hazards model was used to explore the influencing factors of RRMS recurrence risk.Results A total of 127 patients were included in this study,including 40 males and 87 females,with a median age of 27.0(22.0,34.5)years old and an annual recurrence rate of 44.2%(25.4%,65.4%).Based on the results of univariate and multivariate regression analysis of the AG model,it was found that the levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT)and creatine kinase isoenzyme(CK-MB)at the first attack was associated with the recurrence risk of RRMS,and the HR values for each change of 5 units were 1.15(95%CI:1.06-1.26),1.10(95%CI:1.06-1.15)and 1.40(95%CI:1.01-1.95),respectively,the differences were statistically significant(all P<0.05).Conclusion In the serum of patients with RRMS diagnosed for the first time,the increases of AST,ALT and CK-MB levels were related to the increased risk of recurrence,which could provide a reference for clinicians to formulate treatment plans and reduce the occurrence of recurrence.