背景:在多发性硬化症(MS)患者中,自主神经异常症状(DS)很常见,但通常未被识别,尽管对生活质量和身体表现有相关影响。
目的:评估与健康对照(HC)相比,我们的MS人群中DS的频率和特征。探讨DS与疾病特征(MS亚型,疾病持续时间,扩展的残疾状态量表(EDSS),临床和/或放射学活动,残疾进展)。
方法:横断面研究包括324名MS患者(平均年龄44.9±10.7岁;66%为女性)和190名HC患者(平均年龄40.60±12.83岁;63%为女性)。使用意大利验证版本的复合自主症状评分-31(COMPASS-31)评估DS。考虑了可能的混杂因素。
结果:超过94%的入选MS患者报告COMPASS-31量表的≥2个领域有改变(评分>0),与HC相比,COMPASS-31总和单领域中位数得分明显更高,独立于可能的混杂因素(直立不耐受:p=0.001;血管舒缩:p=0.017;分泌运动:p=0.040;胃肠:p=0.047;膀胱:p<0.001;瞳孔运动:p<0.001;COMPASS-31总分:p<0.001)。COMPASS-31总计,分泌运动,胃肠,和膀胱区域评分显示出与疾病持续时间的弱至中度相关性(Rho=0.19,p<0.001;Rho=0.18,p=0.01;Rho=0.25,p=0.030;Rho=0.28,p<0.001)。EDSS评分之间的中度相关性,COMPASS-31总计,和膀胱区域评分(分别为Rho=0.32,p<0.001和Rho=0.48,p<0.001)。进行性亚型显示出较高的COMPASS-31总数(p=0.025),胃肠(p=0.07),和膀胱(p<0.001)域评分与复发缓解患者。
结论:我们的研究结果证实,MS相关的DS是常见的,并且倾向于增加疾病持续时间和临床恶化,在进行性亚型中达到最高的临床影响。
BACKGROUND: Dysautonomic symptoms (DS) are frequent but often underrecognized in multiple sclerosis (MS) patients, despite the relevant impact on quality of life and physical performance.
OBJECTIVE: To assess frequency and characteristics of DS in our MS population compared with healthy controls (HC). To investigate the relationship between DS and disease characteristics (MS subtype, disease duration, Expanded Disability Status Scale (EDSS), clinical and/or radiological activity, disability progression).
METHODS: Cross-sectional study includes 324 MS patients (mean age 44.9 ± 10.7 years; 66% female) and 190 HC (mean age 40.60 ± 12.83 years; 63% female). DS were assessed using the Italian validated version of the Composite Autonomic Symptom Score-31 (COMPASS-31). Possible confounding factors were considered.
RESULTS: More than 94% of enrolled MS patients reported alterations in ≥ 2 domains of the COMPASS-31 scale (score > 0) and significantly higher COMPASS-31 total and single domain median scores compared with HC, independently from possible confounding factors (orthostatic intolerance: p = 0.001; vasomotor: p = 0.017; secretomotor: p = 0.040; gastrointestinal: p = 0.047; bladder: p < 0.001; pupillomotor: p < 0.001; COMPASS-31 total score: p < 0.001). COMPASS-31 total, secretomotor, gastrointestinal, and bladder domain scores showed weak to moderate correlation with disease duration (Rho = 0.19, p < 0.001; Rho = 0.18, p = 0.01; Rho = 0.25, p = 0.030; Rho = 0.28, p < 0.001, respectively). A moderate correlation between EDSS score, COMPASS-31 total, and bladder domain scores (Rho = 0.32, p < 0.001 and Rho = 0.48, p < 0.001, respectively) was observed. Progressive subtypes showed higher COMPASS-31 total (p = 0.025), gastrointestinal (p = 0.07), and bladder (p < 0.001) domain scores vs relapsing-remitting patients.
CONCLUSIONS: Our findings confirm that MS-related DS are frequent and tend to increase paralleling disease duration and clinical worsening, reaching the highest clinical impact in progressive subtypes.