激素暴露与女性视神经脊髓炎临床表型相关(S12.005)

摘要

摘要目的:研究女性视神经脊髓炎谱系障碍(NMOSD)患者激素暴露与疾病特征的关系。背景:NMOSD的男女比例高达9:1，但性别特异性激素在NMO发病机制中的作用尚未被探讨。设计/方法:在8个临床中心对NMOSD(82%]抗体阳性)妇女进行了标准化生殖调查，随后进行了图表审查。使用多变量回归，我们检验了生殖暴露与两种临床结果之间的关系:首次症状出现年龄(FS)和最后一次就诊时的扩展残疾状况量表(EDSS)。对于后者，我们根据年龄和疾病持续时间进行了调整。结果:在217名受访者中，初潮平均年龄为12.8岁(SD 1.7)，平均怀孕次数为2.1次(SD 1.7)，其中0.3次(SD 0.7)发生在NMO诊断后。117名绝经后受试者中，70%报告自然绝经(平均年龄:48.9岁(SD 3.9));不到30%的人报告使用了全身激素治疗。FS年龄平均为40.1 (SD 14.2)。曾经使用系统激素避孕药(HC)与早期FS相关(39年vs 43年，p=0.05)。FS较晚与先前怀孕次数较多相关(p=0.0004)，但受试者年龄对这两个变量的混淆效应不能被解释。最后一次访问时的平均临床严重程度(EDSS)(中位病程:7年)为4(中位3.5,SD 2.2)。持续使用HC与更好的EDSS相关(p=0.002)。在绝经后受试者中，持续使用HT也与更好的EDSS相关(p=0.04，也调整了绝经年龄和类型)，使用HC不再显著(p=0.50)。结论:在本研究中，外源性激素暴露，包括HC和HT，与NMOSD发病年龄较早但残疾较低相关。进一步的研究应该评估这种关联是否有因果关系。

披露:波夫博士没什么可说的。埃尔松博士没什么可透露的。他曾因在Teva Neuroscience、Biogen、Genzyme、Genentech和Novartis的活动获得个人报酬。鲍里索夫医生没什么可透露的。科尔特斯医生没什么好说的。马廷医生没有什么可透露的。米莉医生没什么可说的。索伦博士没什么可透露的。穆奇医生没什么可透露的。托比恩医生没什么好说的。 Dr. Ruprecht has received personal compensation for activities with Bayer Healthcare, Biogen Idec, Merck Serono, Sanofi/Genzyme, Teva, Roche, and Novartis. Dr. Buckle received personal compensation for activities with Accorda Therapeutics, Bayer Healthcare, Biogen-Idec, EMD-Serono, Novartis, Genzyme Corporation, Questcor, and Teva Neuroscience as a consultant. Dr. Levy has received personal compensation for activities with Alexion, Guidepoint Global, and Genzyme. Dr. Levy has received research support from Acorda Therapeutics, Sanofi, Alexian, TG Therapeutics, and TerumoBCT. Dr. Wingerchuk has received personal compensation for serving on a clinical trial adjudication committee for Medimmune. Dr. Wingerchuk has received personal compensation in an editorial capacity for The Neurologist. Dr. Wingerchuk has received research su Dr. Paul has received personal compensation for activities with Teva Neuroscience, Sanofi-Aventis Pharmaceuticals, Inc., Bayer Schering Pharma, Merck Serono, Biogen Idec, Medimmune, and Novartis. Dr. Cross has received personal compensation for activities with Biogen Idec, Genzyme Corporation, GlaxoSmithKline, Inc., Hoffman-La Roche, Teva Neuroscience, Novartis, and Questcor. Dr. Weinshenker has received personal compensation for activities with Novartis, Biogen Idec, Mitsubishi Pharmaceuticals, MedImmune Pharmaceuticals, Chugai, and Chord as a consultant. Dr. Weinshenker has received royalty payments from RSR Ltd. and Oxford Dr. Jacob has nothing to disclose. Dr. Klawiter has received personal compensation for activities with Biogen Idec and Mallinckrodt Pharmaceuticals as a consultant. Dr. Chitnis has received personal compensation for activities with Novartis and Biogen. Dr. Chitnis has received research support from Merck-Serono and Novartis Pharmaceuticals.