{"title":"性激素相关因素与多发性硬化症女性PIRA的风险","authors":"Antonino Giordano, Arianna Giliberti, Ferdinando Clarelli, Kaalindi Misra, Elisabetta Mascia, Melissa Sorosina, Giulia Visentin, Monica Margoni, Lucia Moiola, Maria A Rocca, Massimo Filippi, Federica Esposito","doi":"10.1136/jnnp-2024-335547","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sex-related differences affect multiple sclerosis (MS), but the impact of sex hormones on disease progression remains unclear. We investigated whether sex hormone-related factors influence progression independent of relapse activity (PIRA) in women with MS over a long-term follow-up.</p><p><strong>Methods: </strong>The study analysed 1210 female MS patients from the San Raffaele MS Center using data from an environmental survey (2019-2023). PIRA was defined as 12-week confirmed disability progression independent of recent relapses (<30 days). Cox proportional-hazard models (adjusted for confounding factors) were used to assess the effect of hormone-related factors on PIRA risk.</p><p><strong>Results: </strong>Patients who used oral contraceptives before MS diagnosis had a 26% lower risk of PIRA and a delayed median time to the first PIRA event (9.94 vs 7.5 years; HR=0.74; 95% CI 0.61 to 0.89; p=0.0018). Conversely, menopause at diagnosis (HR=1.82; 95% CI 1.24 to 2.67; p=0.0022) and pregnancy before diagnosis (HR=1.22; 95% CI 1.006 to 1.47; p=0.043) were associated with a shorter time to PIRA. No significant differences were found with abortion, menstrual irregularity or fertility therapy.</p><p><strong>Conclusions: </strong>This study suggests that early oral contraceptives may delay future disability progression, supporting the importance of sex hormones in MS and prompting further prospective investigations on oral contraceptives to slow disease progression.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sex hormone-related factors and the risk of PIRA in women with multiple sclerosis.\",\"authors\":\"Antonino Giordano, Arianna Giliberti, Ferdinando Clarelli, Kaalindi Misra, Elisabetta Mascia, Melissa Sorosina, Giulia Visentin, Monica Margoni, Lucia Moiola, Maria A Rocca, Massimo Filippi, Federica Esposito\",\"doi\":\"10.1136/jnnp-2024-335547\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sex-related differences affect multiple sclerosis (MS), but the impact of sex hormones on disease progression remains unclear. 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引用次数: 0
摘要
背景：性别相关差异影响多发性硬化症（MS），但性激素对疾病进展的影响尚不清楚。我们在长期随访中调查了性激素相关因素是否影响MS女性的独立复发活动（PIRA）的进展。方法：该研究使用2019-2023年环境调查数据分析了圣拉斐尔多发性硬化症中心的1210名女性多发性硬化症患者。PIRA被定义为独立于近期复发的12周确认的残疾进展(结果：MS诊断前使用口服避孕药的患者发生PIRA的风险降低26%，并且延迟到第一次PIRA事件的中位时间(9.94 vs 7.5年；HR = 0.74;95% CI 0.61 ~ 0.89；p = 0.0018)。相反，诊断时绝经(HR=1.82；95% CI 1.24 ~ 2.67；p=0.0022)和诊断前妊娠(HR=1.22；95% CI 1.006 ~ 1.47；p=0.043)与较短的PIRA时间相关。流产、月经不规律或生育治疗方面均无显著差异。结论：本研究提示早期口服避孕药可能延缓未来残疾的进展，支持性激素在MS中的重要性，并促使进一步前瞻性研究口服避孕药延缓疾病进展。
Sex hormone-related factors and the risk of PIRA in women with multiple sclerosis.
Background: Sex-related differences affect multiple sclerosis (MS), but the impact of sex hormones on disease progression remains unclear. We investigated whether sex hormone-related factors influence progression independent of relapse activity (PIRA) in women with MS over a long-term follow-up.
Methods: The study analysed 1210 female MS patients from the San Raffaele MS Center using data from an environmental survey (2019-2023). PIRA was defined as 12-week confirmed disability progression independent of recent relapses (<30 days). Cox proportional-hazard models (adjusted for confounding factors) were used to assess the effect of hormone-related factors on PIRA risk.
Results: Patients who used oral contraceptives before MS diagnosis had a 26% lower risk of PIRA and a delayed median time to the first PIRA event (9.94 vs 7.5 years; HR=0.74; 95% CI 0.61 to 0.89; p=0.0018). Conversely, menopause at diagnosis (HR=1.82; 95% CI 1.24 to 2.67; p=0.0022) and pregnancy before diagnosis (HR=1.22; 95% CI 1.006 to 1.47; p=0.043) were associated with a shorter time to PIRA. No significant differences were found with abortion, menstrual irregularity or fertility therapy.
Conclusions: This study suggests that early oral contraceptives may delay future disability progression, supporting the importance of sex hormones in MS and prompting further prospective investigations on oral contraceptives to slow disease progression.
期刊介绍：
The Journal of Neurology, Neurosurgery & Psychiatry (JNNP) aspires to publish groundbreaking and cutting-edge research worldwide. Covering the entire spectrum of neurological sciences, the journal focuses on common disorders like stroke, multiple sclerosis, Parkinson’s disease, epilepsy, peripheral neuropathy, subarachnoid haemorrhage, and neuropsychiatry, while also addressing complex challenges such as ALS. With early online publication, regular podcasts, and an extensive archive collection boasting the longest half-life in clinical neuroscience journals, JNNP aims to be a trailblazer in the field.
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