一项基于单中心的多发性硬化的临床流行病学回顾性分析

A Single-center Retrospective Analysis of Clinical Epidemiology of Multiple Sclerosis

【目的】总结华南地区多发性硬化(MS)诊断和治疗现状,为我国MS诊治提供参考。【方法】选取中山大学附属第三医院2011年至2019年3月出院第一诊断MS患者,按发病年龄分为儿童组(<14岁)及成人组(≥14岁),从流行病学、症状学、辅助检查及治疗情况进行回顾性分析。【结果】296例患者入组;男女比1∶1.67,发病年龄中位数26岁,复发缓解型占65.9%。首发症状肢体无力130例(43.9%)、感觉障碍118例(39.9%)、视力障碍55例(18.6%),成人与儿童组感觉障碍(114vs.4,Z=-2.155,P=0.031)与发作性症状(4vs.3,Z=-3.610,P=0.000)有统计学差异;复发症状方面,总复发次数712次,其中肢体无力380次(53.4%),感觉障碍265次(37.2%),视力障碍134次(18.8%),成人组与儿童组在运动、感觉、视力、其它眼部症状及发作性症状方面均有统计学差异;脑脊液寡克隆带(OCB)阳性率45.5%,MOG抗体阳性率16.7%。MRI显示脑室旁T2病灶≥9患者57.4%,皮质与近皮质病灶28.1%,幕下病灶0.3%,视神经病灶63.2%,两组无统计学差异。既往治疗药物包括糖皮质激素(使用率79.7%),β干扰素(15.9%),硫唑嘌呤(13.9%);目前正在使用治疗药物包括糖皮质激素(15.5%),利妥昔单抗(9.1%),硫唑嘌呤(8.1%),特立氟胺(8.1%)。【结论】MS的发病年龄、性别、临床症状、影像学等信息与亚洲既往文献报道相似。治疗方面,新型疾病修饰治疗(DMT)药物使用呈上升趋势。

【Objective】To summarize current situation of multiple sclerosis in South China and provide reference for MS diagnosis and treatment.【Methods】We selected patients of whom the first diagnosis was MS from 2011 to March 2019,and divided them into Adults group and Pediatrics group according to onset age above or below 14. We analyzed them from epidemiology,symptomatology,accessory examinations and treatment situation.【Results】296 patients were admitted into this research. The ratio of male to female was 1 ∶1.67. Median onset age was 26. Relapsing-remitting MS accounted for 63.2% of all patients. For initial episode,130 patients had motor symptoms(43.9%),118 patients showed sensory symptoms(39.9%),and 55 patients were accompanied with visual symptoms(18.6%). Statistical difference exists in sensory symptoms(114 vs. 4,Z =-2.155,P = 0.031) and paroxysmal symptoms(4 vs. 3,Z =-3.610,P = 0.000) of Adults group and Pediatrics group. For following episodes, the total relapsing time was 712,with motor symptoms relapsing 380 times(53.4%),sensory symptoms 265 times(37.2%)and visual symptoms 134 times(18.8%). Statistical difference existed in motor,sensory,visual,other ocular symptoms and paroxysmal symptoms. Positive rate of Oligoclonal bond was 45.5%. Positive rate of MOG-Ab was 16.7%. For brain MRI,periventricular lesions ≥ 9 accounted for 57.4% of all patients,with cortical & juxtacortical lesions 28.1% and infratentorial lesions 0.3%. Patients who had optic nerve lesions accounted for 63.2%. No statistical difference existed in them. For treatment,drugs they had used previously were glucocorticoid(79.7%),beta Interferon(15.9%)and azathioprine(13.9%).During the study,drugs they were using were glucocorticoid(15.5%),rituximab(9.1%),azathioprine(8.1%)and teriflunomide(8.1%).【Conclusions】For gender, age,symptomatology and accessory examinations,results of this research are similar to previous papers about multiple sclerosis in Asian. For treatment,the trend indicates that usage of new disease-modifying drugs goes up.