■多发性硬化症(MS)的性别特异性分析报告很少。残疾累积起因于复发(复发相关恶化)和其独立(独立于复发的进展)。
根据扩展残疾状态量表(EDSS)的变化,分析了按标准治疗复发的MS患者群体的性别差异和短期复发结果(3-6个月)。
■单中心回顾性研究。
■我们分析了2016年3月至2020年8月的134例MS复发。所有事件都需要复发治疗(类固醇和/或血浆置换)。人口统计,疾病,临床特征[脑脊液(CSF)和磁共振成像(MRI)]按性别分开显示。进行多变量线性回归以确定与短期EDSS变化相关的因素。
■复发时的平均年龄为38.4岁(95%置信区间:36.3-40.4),在我们的队列中有71.6%的女性。男性吸烟(65.8%)是女性(32.3%)的两倍多。男性复发和复发后EDSSs较高[男性:3.3(2.8-3.9),女性:2.7(2.4-3.0);男性:3.0(1.3-3.6);女性:1.8(1.5-2.1)]尽管类似的复发干预。临床参数显示没有性别差异。我们的主要模型确定了女性,年龄较小,复发时EDSS升高与EDSS改善相关。较高的免疫球蛋白G(IgG)商(CSF/血清)与较差的短期预后相关[第一次复发治疗和最后一次EDSS评估之间的平均天数130.2(79.3-181.0)]。
■性别和性别差异在MS复发的结局分析中很重要。有效的治疗方案需要考虑假定的不良结果标志物,以改变长期预后,如临床和人口统计学变量。鞘内IgG合成补充。应该设计前瞻性试验来解决这些差异并确认我们的结果。
对134例多发性硬化症急性复发的分析显示,性别差异会影响复发的恢复。性别特异性分析在医学上很重要,但是仍然需要更多的知识。多发性硬化症(MS)作为脑和脊髓的炎症性疾病主要影响处于残疾发展风险的年轻人。残疾可能是由于疾病的急性复发而无法充分恢复。我们的分析旨在评估性别差异,特别关注急性复发和平均3至6个月后。我们从我们的中心收集了现有数据,并确定了134例复发事件,并有足够的数据用于进一步分析。所有复发均采用药物治疗(高剂量类固醇)和/或介入治疗(血浆置换)。我们分析了性的影响,年龄,吸烟,复发严重程度,MS的复发治疗和其他治疗(免疫疗法)。在第二个分析中,包括脑脊液(CSF)和影像学(MRI)参数。我们的队列包括72%的女性。平均年龄为38岁。吸烟在男性(66%)是女性(32%)的两倍。男性在复发期间和之后也经历了更严重的残疾。其他几个因素在男性和女性之间是相似的。女性和年轻的年龄与复发后较低的残疾有关。矛盾的是,此外,复发患者的高致残率与后来的低致残率相关.这可能是一种统计现象,部分原因是我们的分析中总体残疾水平较低。因此,对于具有更高残疾的更晚期疾病阶段,这可能不是真的。某种CSF标记物(鞘内IgG合成)的存在与复发后更高的残疾有关。因此,我们的分析确定了与不同复发恢复相关的标志物,男性vs.女性是其中之一。
UNASSIGNED: Reporting of sex-specific analyses in multiple sclerosis (MS) is sparse. Disability accrual results from relapses (relapse-associated worsening) and independent thereof (progression independent of relapses).
UNASSIGNED: A population of MS patients during relapse treated per standard of care was analyzed for sex differences and short-term relapse outcome (3-6 months) as measured by Expanded Disability Status Scale (EDSS) change.
UNASSIGNED: Single-center retrospective
study.
UNASSIGNED: We analyzed 134 MS relapses between March 2016 and August 2020. All events required relapse treatment (steroids and/or plasma exchange). Demographic, disease, and paraclinical characteristics [cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI)] were displayed separated by sex. Multivariable linear regression was run to identify factors associated with short-term EDSS change.
UNASSIGNED: Mean age at relapse was 38.4 years (95% confidence interval: 36.3-40.4) with a proportion of 71.6% women in our cohort. Smoking was more than twice as prevalent in men (65.8%) than women (32.3%). In- and after-relapse EDSSs were higher in men [men: 3.3 (2.8-3.9), women: 2.7 (2.4-3.0); men: 3.0 (1.3-3.6); women: 1.8 (1.5-2.1)] despite similar relapse intervention. Paraclinical parameters revealed no sex differences. Our primary model identified female sex, younger age, and higher EDSS at relapse to be associated with EDSS improvement. A higher immunoglobulin G (IgG) quotient (CSF/serum) was associated with poorer short-term outcome [mean days between first relapse treatment and last EDSS assessment 130.2 (79.3-181.0)].
UNASSIGNED: Sex and gender differences are important in outcome analyses of MS relapses. Effective treatment regimens need to respect putative markers for a worse outcome to modify long-term prognosis such as clinical and demographic variables, complemented by intrathecal IgG synthesis. Prospective trials should be designed to address these differences and confirm our results.
An analysis of 134 acute relapses of multiple sclerosis reveal sex differences influencing recovery from relapse Sex-specific analyses are important in medicine, but more knowledge is still needed. Multiple sclerosis (MS) as an inflammatory disease of the brain and spinal cord mainly affects younger people who are at risk for development of disability. Disability may result from acute relapses of the disease that insufficiently recover. Our analysis aimed to assess sex differences with a special focus on the acute relapse and 3 to 6 months later on average. We collected existing data from our center and identified 134 relapse events with sufficient data for further analysis. All relapses were treated with medical (high-dose steroids) and/or interventional treatment (plasma exchange). We analyzed the influence of sex, age, smoking, relapse severity, relapse treatment and other treatment (immunotherapy) for MS. In a second analysis, cerebrospinal fluid (CSF) and imaging (MRI) parameters were included. Our cohort consisted of 72% women. The mean age was 38 years. Smoking was twice as common in men (66%) than in women (32%). Men also experienced more severe disability in and after the relapse. Several other factors were similar between men and women. Female sex and younger age were associated with lower disability after a relapse. Paradoxically, also higher disability in the relapse was associated with lower disability later on. This might be a statistical phenomenon and partly explained by overall low disability levels in our analysis. It might therefore not be true for more advanced disease stages with higher disability. The presence of a certain CSF marker (intrathecal IgG synthesis) was associated with higher disability after the relapse. Our analysis thus identified markers associated with different relapse recovery, male vs. female sex being one of them.