妊娠对视神经脊髓炎谱系疾病与多发性硬化病程的影响

Influence of pregnancy on the course of neuromyelitis optica spectrum disorders and multiple sclerosis

目的观察妊娠分娩对视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)与多发性硬化(multiple sclerosis,MS)疾病进程的影响。方法筛选有妊娠史NMOSD患者61例、MS患者68例,回顾性收集其发病年龄、复发次数与时间、妊娠与结局,比较分析NMOSD与MS妊娠期间与产后2年内不同阶段发病与复发情况。结果 (1)NMOSD患者妊娠期疾病发生率高于MS患者(6.56%比0,P=0.047),两者妊娠期复发率(1.45%比1.53%,P=1.000)、产后2年内疾病发生率(31.15%比26.47%;χ~2=0.344,P=0.558)及产后2年内复发率(21.74%比18.77%;χ~2=0.500,P=0.480)比较差异均无统计学意义。(2)NMOSD患者产后≤3个月年均复发率(annualized relapse rate,ARR;以中位数(四分位数间距)表示,下同)最高[4(4)次/年],高于产后3~6个月[0(0)次/年,P=0.015]、12~24个月[0(0)次/年,P=0.006],且产后第1年ARR高于产后第2年ARR[1(0.75)次/年比0(0)次/年,P=0.001],MS患者产后9~12个月ARR显著高于产后6~9个月[(0(4)次/年比0(0)次/年,P=0.005],产后第1年ARR与产后第2年ARR比较差异无统计学意义[1(0)次/年比0(1)次/年,P=0.069]。NMOSD患者产后≤3个月ARR[4(4)次/年比0(4)次/年,P=0.046]与6~9个月ARR[0(0)次/年比0(0)次/年,P=0.042]均高于MS患者。结论 NMOSD患者妊娠期疾病发生率高于MS,产后发生率及复发率均较高,但不同阶段ARR存在统计学差异。

Objective To investigate the effect of pregnancy and delivery/abortion on disease progression of neuromyelitis optica spectrum disorders(NMOSD)and multiple sclerosis(MS).Methods Sixty-one NMOSD patients and sixty-eight MS patients who had histories of pregnancies were selected,and their incidence of pregnancy and outcome,age of onset and relapse frequency were collected retrospectively.The changes of ARR in NMOSD and MS during pregnancy and postpartum were analyzed.Results(1)The proportion of patients with NMOSD onset during pregnancy was higher than that of MS(6.56%vs.0,P=0.047).The proportions of disease relapses during pregnancy(1.45%vs.1.53%,P=1.000),the proportions of disease onset(31.15%vs.26.47%;χ2=0.344,P=0.558)and relapses(21.74%vs.18.77%;χ2=0.500,P=0.480)in 2 years after delivery/abortion between them were not statistically significant.(2)The annualized relapse rate(ARR)during the first 3 months postpartum period of NMOSD[median(interquartile range):4(4)times/year]was higher significantly than ARR during 3-6 months and 12-24 months postpartum periods[0(0)times/year and 0(0)times/year;P=0.015,P=0.006,respectively);and ARR during the first year postpartum period was significantly higher than ARR during the second year postpartum period[1(0.75)times/year vs.0(0)times/year,P=0.001).As to MS,ARR during the 9-12 months postpartum period was higher significantly than ARR during the 6-9 months postpartum period[0(4)times/year vs.0(0)times/year,P=0.005),but ARRs between the first year and second year postpartum period were not different significantly[1(0)times/year vs.0(1)times/year,P=0.069).The ARR of NMOSD patients during 0-3 months and 6-9 months postpartum periods were both significantly higher than that of MS patients[4(4)times/year vs.0(4)times/year,P=0.046;0(0)times/year vs.0(0)times/year,P=0.042).Conclusions Comparing with MS,the disease onset of NMOSD patients were more closely related to pregnancy.Both NMOSD and MS had more onset and relapses after delivery/abortion,and there were significant differences in ARRs at different stages.