Arch Neurol.：吸烟会恶化多发性硬化症

高原

吸烟对人体造成的众多危害已为人所知。美国科研人员在最新一项研究中发现，吸烟还会导致多发性硬化症恶化。多发性硬化症是一种免疫系统错误攻击自身机体的自体免疫疾病，根据病损部位不同，多发性硬化症可引起人体多种功能障碍。美国波士顿医学院的研究人员在7月刊的《神经病学文献》上报告说，他们对1465名多发性硬化症患者进行了调查。被调查者平均年龄42岁，患病平均时间为9．4年。他们当中的257人现在仍然吸烟，428人曾经吸烟但后来戒烟，780人从不吸烟。调查开始时，吸烟患者的多发性硬化症病情就已经比其他两组人严重。随后，研究人员平均每隔3年对调查者进行一次回访，以确定他们多发性硬化症的发展情况。结果发现，与其他两组人相比，吸烟患者的多发性硬化症的病情出现恶化的概率最高。研究人员由此得出结论，吸烟会加剧多发性硬化症的病情。（生物谷Bioon.com）生物谷推荐原始出处：ArchNeurol.2009;66（7）:858-864.SmokingandDiseaseProgressioninMultipleSclerosisBrianC.Healy,PhD;EmanN.Ali,MD;CharlesR.G.Guttmann,MD;TanujaChitnis,MD;BonnieI.Glanz,PhD;GuyBuckle,MD;MariaHoutchens,MD;LynnStazzone,MSN,NP;JenniferMoodie,MD;AnnikaM.Berger,MD;YangDuan,MD;RohitBakshi,MD;SamiaKhoury,MD;HowardWeiner,MD;AlbertoAscherio,MDBackgroundAlthoughcigarettesmokersareatincreasedriskofdevelopingmultiplesclerosis（MS）,theeffectofsmokingontheprogressionofMSremainsuncertain.ObjectiveToestablishtherelationshipbetweencigarettesmokingandprogressionofMSusingclinicalandmagneticresonanceimagingoutcomesDesignCross-sectionalsurveyandlongitudinalfollow-upforameanof3.29years,endingJanuary15,2008.SettingPartnersMSCenter（Boston,Massachusetts）,areferralcenterforpatientswithMS.PatientsStudyparticipantsincluded1465patientswithclinicallydefiniteMS（25.1%men）,withmean（range）ageatbaselineof42.0（16-75）yearsanddiseasedurationof9.4（0-50.4）years.Sevenhundredeightypatients（53.2%）werenever-smokers,428（29.2%）wereex-smokers,and257（17.5%）werecurrentsmokers.MainOutcomeMeasuresSmokinggroupswerecomparedforbaselineclinicalandmagneticresonanceimagingcharacteristicsaswellasprogressionandsustainedprogressionontheExpandedDisabilityStatusScaleat2and5yearsandtimetodiseaseconversiontosecondaryprogressiveMS.Inaddition,therateofon-studychangeinthebrainparenchymalfractionandT2hyperintenselesionvolumewerecompared.ResultsCurrentsmokershadsignificantlyworsediseaseatbaselinethannever-smokersintermsofExpandedDisabilityStatusScalescore（adjustedP<.001）,MultipleSclerosisSeverityScore（adjustedP<.001）,andbrainparenchymalfraction（adjustedP=.004）.Inaddition,currentsmokersweresignificantlymorelikelytohaveprimaryprogressiveMS（adjustedoddsratio,2.41;95%confidenceinterval,1.09-5.34）.Atlongitudinalanalyses,MSinsmokersprogressedfromrelapsing-remittingtosecondaryprogressivediseasefasterthaninnever-smokers（hazardratioforcurrentsmokersvsnever-smokers,2.50;95%confidenceinterval,1.42-4.41）.Inaddition,insmokers,theT2-weightedlesionvolumeincreasedfaster（P=.02）,andbrainparenchymalfractiondecreasedfaster（P=.02）.ConclusionOurdatasuggestthatcigarettesmokehasanadverseinfluenceontheprogressionofMSandacceleratesconversionfromarelapsing-remittingtoaprogressivecourse.

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