多发性硬化症的自然病史:一个统一的概念

来源 :世界核心医学期刊文摘(神经病学分册) | 被引量 : 0次 | 上传用户:num184015922
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
Multiple sclerosis can follow very different patterns of evolution and variable rates of disability accumulation. This raises the issue whether it represents one or several distinct diseases. We assessed demographic and clinical characteristics in 1844 patients with multiple sclerosis that we categorized according to the classification of Lublin and Reingold (1996) into 1066 (58% ) relapsing- remitting, 496 (27% ) secondary progressive, 109 (6% ) progressive relapsing and 173 (9% ) primary progressive cases of multiple sclerosis. Relapsing- remitting and secondary progressive cases shared similar age at disease onset (median = 28.7 versus 29.5 years; P = 0.21), initial symptoms of the relapsing- remitting phase, degree of recovery from the first neurological episode, and time from the first to the second episode. By contrast, disease duration was twice as long in secondary progressive than in relapsing- remitting cases (mean ± SD = 17.6 ± 9.6 versus 8.7 ± 8.6 years; P < 0.001). Progressive relapsing and primary progressive cases were essentially similar in their clinical characteristics. In patients experiencing a progressive course, median age at onset of progressive phase was similar in secondary progressive cases and in cases who were progressive from onset (39.1 versus 40.1 years; P = 0.47). The proportion of cases with superimposed relapses during progression was ~ 40% in both categories. Finally, the 1562 patients with an exacerbating- remitting initial course and the 282 patients with a progressive initial course of the disease were essentially similar with respect to the time course of disability accumulation from assignment to a given disability score, and the age at assignment of disability landmarks. These observational data suggest that the clinical phenotype and course of multiple sclerosis are age dependent. Relapsingremitting disease can be regarded as multiple sclerosis in which insufficient time has elapsed for the conversion to secondary progression; secondary progressive forms as relapsing- remitting multiple sclerosis that has ‘ grown older’; and progressive from onset cases as multiple sclerosis ‘ amputated’ from the usual preceding relapsing- remitting phase. Times to reach disability milestones, and ages at which these landmarks are reached, follow a predefined schedule not obviously influenced by relapses, whenever they may occur, or by the initial course of the disease, whatever its phenotype. This leads to a unifying concept of the disease in which primary and secondary progression might be regarded as essentially similar. From the clinical and statistical positions, multiple sclerosis might be considered as one disease with different clinical phenotypes rather than an entity encompassing several distinct diseases - the position of complexity rather than true heterogeneity. Multiple sclerosis can follow very different patterns of evolution and variable rates of disability accumulation. This raises the issue whether it represents one or several distinct diseases. We assessed demographic and clinical characteristics in 1844 patients with multiple sclerosis that we categorized according to the classification of Lublin Relapsing-remitting, 496 (27%) secondary progressive, 109 (6%) progressive relapsing and 173 (9%) primary progressive cases of multiple sclerosis shared similar age at disease onset (median = 28.7 versus 29.5 years; P = 0.21), initial symptoms of the relapsing-remitting phase, degree of recovery from the first neurological episode, and time from the first to the second episode. By contrast, disease duration was twice as long in secondary progressive than in relapsing-remitting cases (mean ± SD = 17.6 ± 9.6 versus 8.7 ± 8.6 years; P <0.001) Prog In patients experiencing a progressive course, median age at onset of progressive phase was similar in secondary progressive cases and in cases who were progressive from onset (39.1 versus 40.1 years; P = 0.47). The proportion of cases with superimposed relapses during progression was ~ 40% in both categories. Finally, the 1562 patients with an exacerbating- remitting initial course and the 282 patients with a progressive initial course of the disease were similar with respect to the time course of disability accumulation from assignment to disded score, and the age at assignment of disability landmarks. The observational data suggest that the clinical phenotype and course of multiple sclerosis are age dependent. Relapsingremitting disease can be as multiple sclerosis in which insufficient time has elapsed for the conversion to secondary progr ession; secondary progressive forms as relapsing- remitting multiple sclerosis that has ’grown older’; and progressive from onset cases as multiple sclerosis ’amputated’ from the usual preceding relapsing- remitting phase. Times to reach disability milestones, and ages at which these landmarks are reached, follow a predefined schedule not obviously influenced by relapses, whenever they may occur, or by the initial course of the disease, whatever its phenotype. This leads to a unifying concept of the disease in which primary and secondary progression might be rated as From the clinical and statistical positions, multiple sclerosis might be considered as one disease with different clinical phenotypes rather than an entity encompassing several distinct diseases - the position of complexity rather than true heterogeneity.
其他文献
在世界最深的马里亚纳海沟深处,海水又冷又暗,千万年来沉寂无声,连低等植物都无法生长。但偶尔会发现一些小光亮缓缓移动,那是从一种叫安康鱼的身上发射出来的光芒。原来,安康鱼的背上生长着一种奇怪的发光器,每当它游动的时候,发光器就像一盏玲珑的小灯笼,将暗无天日的深海照出一片光亮来,而安康鱼就在这片光亮下活着,生儿育女,一代一代地繁殖着。  与安康鱼的特异功能相比,还有一种叫风流草的植物,同样神奇。它生长
请下载后查看,本文暂不支持在线获取查看简介。 Please download to view, this article does not support online access to view profile.
“什么?明天要秋游,去森林公园。”一听到班主任老师宣布的消息。教室里像炸开了锅,同学们兴奋起来。第二天一早,我迫不及待地到了学校,八点整我们就正式出发了。走啊走啊,怎
摘要:本文从增加思维含量,唤醒主体意识;联系文体特点,促进理解感悟;揣摩语言特色,增长言语智慧三个方面阐述了在阅读教学中夯实语文实践的探索和启示。  关键词:阅读教学;语文实践  中图分类号:G427 文献标识码:A 文章编号:1992-7711(2014)21-092-1  2011年版语文课程课标指出“语文是实践性很强的课程,应着重培养学生的语文实践能力,而培养这种能力的主要途径也应是语文实践
目的 比较小剂量抗抑郁药物盐酸帕罗西汀和匹维溴胺与单独应用匹维溴胺治疗肠易激综合征的疗效。方法 将 70例符合罗马Ⅰ诊断标准的肠易激综合征患者随机分为两组 :治疗组
北京市朝阳区垡头小学是一所具有54年历史的老校。“文化浸润,和谐发展”办学理念的提出为学校的发展指明了方向:“建设书香校园,培育君子文化,奠基和谐人生,造福一方百姓”
从2000年起,山西师大实验中学就把研究性学习活动确立为学校教学工作的重要内容,要求教师、学生全员参与。在研究性学习活动方面,学校主要抓好以下几个方面。一、互动式的课
从前,有一位美丽的公主,她得了一种奇怪的病,整天闷闷不乐。“到底什么能让你快乐起来呢?”国王愁坏了。“花,最美的花!”公主撅着嘴巴说。公主是国王的掌上明珠,为了让她开
北京市西城区厂桥小学是一所百年老校,始建于1904年,地处平安大街。2014年5月,学校与护国寺小学合并,目前有33个教学班、1100名学生、近100名教职员工,占地面积近8000平方米,
慢性胰腺炎并发脾内假性囊肿形成一例