85例多系统萎缩患者预后影响因素的分析

目的:探讨多系统萎缩(multiple system atrophy,MSA)患者预后的影响因素。方法:连续收集2016年1月到2019年1月空军军医大学第一附属医院神经内科住院及门诊收治的85名临床确诊MSA患者的临床资料,每隔6月对患者进行随访记录,直至需辅助行走时间,研究时限3.5年,筛选10个可能影响MSA独立行走的危险因素,应用Cox比例风险回归模型进行单因素及多因素回归分析。结果:85例MSA患者中,很可能MSA38例(44.7%),可能MSA47例(55.3%),以帕金森表现(MSA-P)43例(50.6%),以小脑性共济失调表现(MSA-C)42例(49.4%),男性46例(54.1%),女性39例(45.9%),起病年龄54.7±8.8岁,首发运动症状30例(35.3%),首发非运动症状55例(64.7%)。起病至非运动症状合并运动症状中位时程27.9(11.5, 40.5)月。截至本研究终止,28例(32.9%)患者独立行走,57例(67.1%)患者不能独立行走,起病至辅助行走中位时程36.0(22.5, 54.0)月。Cox比例风险回归模型显示起病年龄大(HR=1.041, 95%CI 1.000-1.083, P=0.049)、HY高分期(HR=2.015,95%CI 1.031-3.938,P=0.040)、起病至非运动症状合并运动症状短时程(HR=0.980,95%CI 0.967-0.993, P=0.003)是MSA患者发展至辅助行走状态的危险因素。结论:起病年龄大、HY高分期、起病至非运动症状合并运动症状短时程是MSA患者辅助行走的不良预后因素。

Analysis of Prognostic Factors in 85 Patients with Multiple System Atrophy

ABSTRACT Objective: To explore the relevant factors on the prognosis of patients with multiple system atrophy (MSA). Methods: The clinical data of 85 clinically diagnosed MSA patients admitted to the Department of Neurology, First Affiliated Hospital of Air Force Military Medical University was collected from January 2016 to January 2019. These MSA patients were followed up every 6 months until they needed aid to walk. The study time limit is 3.5 years. 10 factors that may affect independent walking of MSA patients were screened for survival analysis. These factors were studied by Cox proportional hazard regression model for univariate and multivariate regression analysis. Results: In this study, there were 38 cases of probable MSA patients (44.7 %), 47 cases (55.3 %) of possible MSA patients, 43 cases (50.6 %) with Parkinson''s disease-like symptoms (MSA-P), 42 cases (49.4 %) with cerebellar syndrome (MSA-C). Among them, 46 patients (54.1 %) were male, 39 patients (45.9 %) were female, with onset age of 54.7 ± 8.8 years. 30 patients (35.3 %) suffered from the onset of motor symptoms, 55 patients (64.7 %) suffered from the onset of non-motor symptoms. The median time between onset of MSA and non-motor symptoms combined with motor symptoms was 27.9(11.5, 40.5) months. As of the end of the study, 28 patients (32.9 %) were able to walk independently, and 57 patients (67.1 %) were unable to walk independently. The median time between onset of MSA and dependent ambulation was 36.0 (22.5, 54.0) months. The Cox proportional hazard regression model suggested an old age (HR=1.041, 95 % CI 1.000 to 1.083, P=0.049), H&Y high-stage (HR=2.015, 95 % CI 1.031 to 3.938, P=0.040), short duration from onset of MSA to non-motor symptoms combined with motor symptoms (HR=0.980, 95 % CI 0.967 to 0.993, P=0.003) were independent risky factors for predicting the development of MSA patients to dependent ambulation. Conclusion: The old age, H&Y high- stage, short duration from onset of MSA to non-motor symptoms combined with motor symptoms are prognostic risk factors for MSA patients.