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Abstract：
OBJECTIVE: The association between onset age and sex with relapse risk in neuromyelitis optica spectrum disorder (NMOSD) remains inconclusive. We aimed to describe the clinical features of patients with NMOSD in different age groups and sexes and to analyse relapse characteristics pre- and post-immunosuppressive therapy (IST).
METHODS: Patients with NMOSD were retrospectively reviewed from our clinical centre\'s database. Demographic and clinical data, attack presentation, and disease course pre- and post-IST were investigated. We also analysed the effect of onset age on the annualized relapse rate and relapse risk according to sex and IST status. Interactions on the additive scale between onset age and sex were analysed. A restricted cubic spline was used to analyse potential nonlinear correlations. Longitudinal changes in the Expanded Disability Status Scale score across NMOSD attacks were analysed using linear mixed-effect models.
RESULTS: In total, 533 patients experienced 1394 attacks pre-IST and 753 relapses post-IST. Older age at onset was correlated with more myelitis attacks but fewer optic neuritis attacks, with no sex-related differences in attack presentation. Pre-IST, relapse risk increased with age at onset in women, while a U-shaped correlation between onset age and relapse risk was found in men. Post-IST, an inverted U-shaped association between the predicted relapse risk and onset age was observed in women. Conversely, a negative correlation between the predicted relapse risk and onset age was found in men. Overall, a higher ratio of myelitis attacks was found post-IST.
CONCLUSIONS: Patients of different onset ages and sexes had different relapse patterns before and after IST.
METHODS: Patients with NMOSD were retrospectively reviewed from our clinical centre\'s database. Demographic and clinical data, attack presentation, and disease course pre- and post-IST were investigated. We also analysed the effect of onset age on the annualized relapse rate and relapse risk according to sex and IST status. Interactions on the additive scale between onset age and sex were analysed. A restricted cubic spline was used to analyse potential nonlinear correlations. Longitudinal changes in the Expanded Disability Status Scale score across NMOSD attacks were analysed using linear mixed-effect models.
RESULTS: In total, 533 patients experienced 1394 attacks pre-IST and 753 relapses post-IST. Older age at onset was correlated with more myelitis attacks but fewer optic neuritis attacks, with no sex-related differences in attack presentation. Pre-IST, relapse risk increased with age at onset in women, while a U-shaped correlation between onset age and relapse risk was found in men. Post-IST, an inverted U-shaped association between the predicted relapse risk and onset age was observed in women. Conversely, a negative correlation between the predicted relapse risk and onset age was found in men. Overall, a higher ratio of myelitis attacks was found post-IST.
CONCLUSIONS: Patients of different onset ages and sexes had different relapse patterns before and after IST.
摘要：
目的：视神经脊髓炎谱系障碍（NMOSD）的发病年龄和性别与复发风险之间的关系仍不确定。我们旨在描述不同年龄段和性别的NMOSD患者的临床特征，并分析免疫抑制治疗（IST）前后的复发特征。
方法：从我们临床中心的数据库中对患有NMOSD的患者进行回顾性分析。人口统计学和临床数据，攻击演示,并对IST前后的病程进行了调查。我们还根据性别和IST状态分析了发病年龄对年度复发率和复发风险的影响。分析了发病年龄和性别之间在累加尺度上的相互作用。使用有限的三次样条来分析潜在的非线性相关性。使用线性混合效应模型分析了NMOSD攻击期间扩展残疾状态量表得分的纵向变化。
结果：总计，533例患者经历了1394例IST前发作，753例IST后复发。发病年龄较大与较多脊髓炎发作相关，但视神经炎发作较少。在攻击表现上没有与性别相关的差异。Pre-IST,复发风险随着女性发病年龄的增加而增加，而在男性中发现发病年龄和复发风险之间存在U型相关性。IST后,在女性中观察到预测的复发风险与发病年龄之间呈倒U型关联.相反，在男性中发现预测的复发风险与发病年龄之间呈负相关。总的来说,IST后发现脊髓炎发作比例较高.
结论：不同发病年龄和性别的患者在IST前后有不同的复发模式。
方法：从我们临床中心的数据库中对患有NMOSD的患者进行回顾性分析。人口统计学和临床数据，攻击演示,并对IST前后的病程进行了调查。我们还根据性别和IST状态分析了发病年龄对年度复发率和复发风险的影响。分析了发病年龄和性别之间在累加尺度上的相互作用。使用有限的三次样条来分析潜在的非线性相关性。使用线性混合效应模型分析了NMOSD攻击期间扩展残疾状态量表得分的纵向变化。
结果：总计，533例患者经历了1394例IST前发作，753例IST后复发。发病年龄较大与较多脊髓炎发作相关，但视神经炎发作较少。在攻击表现上没有与性别相关的差异。Pre-IST,复发风险随着女性发病年龄的增加而增加，而在男性中发现发病年龄和复发风险之间存在U型相关性。IST后,在女性中观察到预测的复发风险与发病年龄之间呈倒U型关联.相反，在男性中发现预测的复发风险与发病年龄之间呈负相关。总的来说,IST后发现脊髓炎发作比例较高.
结论：不同发病年龄和性别的患者在IST前后有不同的复发模式。
