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影响多系统萎缩患者独立行走能力的因素分析

Prognostic factors for inability to walk independently in patients with multiple system atrophy

摘要:

目的探讨影响多系统萎缩( MSA )患者独立行走能力的因素。方法回顾性分析2013年2月至2016年2月就诊于海军总医院和北京中医药大学第二临床医学院东方医院的123例MSA患者临床资料和随访记录,并于2016年2月统一进行电话随访,应用代表日常生活活动能力( ADL)的第2重要事件即患者失去独立行走能力来评价预后,考察8个可能影响MSA独立行走能力的因素,应用Cox比例风险回归模型进行预后分析。结果123例MSA患者中,男74例,女49例,男女性别比为1.51∶1;MSA-C型70例,MSA-P型53例,亚型比( C∶P)为1.32∶1;起病年龄为(53±8)岁;所有患者均有严重的自主神经功能障碍。截至研究结束,有56例(45.5%)患者不能独立行走,从起病至失去独立行走能力的中位时间为73个月。 Cox比例风险回归模型分析显示,起病年龄≥55岁( HR=1.969,95%CI 1.095~3.542, P=0.024)、发展至出现合并症状(定义为同时有运动症候和非运动症候)的时间间隔≤3年(HR=2.308,95%CI 1.158~4.600, P=0.017)是MSA患者失去独立行走能力的独立影响因素,而性别、临床亚型、首发症状、饮酒、吸烟、毒物暴露对MSA的独立行走能力无显著影响(P值均>0.05)。结论55岁以后起病、起病3年内即出现合并症状的MSA患者会更快地失去独立行走能力,可作为MSA患者失去独立行走能力的预测指标。性别、临床亚型、首发症状、饮酒、吸烟、毒物暴露尽管在本研究中未显示为MSA独立行走能力的影响因素,但对MSA预后的影响还需进一步考证。

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abstracts:

Objective To explore the prognostic factors for inability to walk independently in patients with multiple system atrophy (MSA).Methods A total of 123 patients with clinically confirmed MSA admitted to Navy General Hospital and Dongfang Hospital affiliated to the Second Clinical Medical College of Beijing University of Chinese Medicine , from February 2013 to February 2016, were retrospectively reviewed .Clinical data and all records were collected and all subjects were followed up by a telephone call in February 2016.The second milestone of activities of daily living scale (ADL), defined as inability to walk independently , was taken as the primary outcome .Eight possible prognostic factors were investigated and the survival analysis was performed with Cox proportional hazards model regression .Results Of all the MSA patients, 74 subjects were men and 49 were women with a sex radio of 1.51∶1(M∶F).Seventy cases were diagnosed with MSA-cerebellar type ( MSA-C ) and 53 with MSA-Parkinson type ( MSA-P ) (C∶P=1.32∶1).Mean age at the onset of first symptom was (53 ±8) years old.All patients had severe autonomic nervous dysfunction . At the last follow-up, 56 cases ( 45.5%) were unable to walk independently .The median survival time from the onset of MSA to inability to walk independently was 73 months.The age of onset ≥55 years (HR=1.969, 95%CI 1.095-3.542, P=0.024) and the interval time from disease onset to combined motor and autonomic involvement ≤3 years ( HR =2.308, 95%CI 1.158-4.600, P=0.017) were independent prognostic factors for inability to walk independently ,while gender, MSA clinical subtypes, initial symptoms, alcohol intake, smoking and toxic exposure were not indicators for independent walking (P>0.05).Conclusions The prognostic factors for inability to walk independently in patients with MSA are the age of onset ≥55 years and the interval time from disease onset to combined motor and autonomic involvement≤3 years.Although factors including gender , MSA clinical subtypes , initial symptoms , alcohol intake , smoking and toxic exposure are not the predictive factors for inability to walk independently in our MSA patients , their roles in the prognosis of MSA still need further investigation .

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作者: 王志伟 [1] 吴兴华 [1] 邱峰 [1] 刘建国 [1] 姚伟 [1] 江墨 [2] 王粟实 [2] 陈志刚 [2] 戚晓昆 [1]
期刊: 《中华内科杂志》2017年56卷2期 94-98页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0578-1426.2017.02.003
发布时间: 2017-03-17
基金项目:
首都临床特色应用研究专项课题(Z151100004015017)Fund programCapital Clinical Characteristic Application Research Subject
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