Association between active and passive smoking and the clinical course of multiple sclerosis and neuromyelitis optica spectrum disorder
Objective:Active and passive smoking are common environmental risk factors,but there is no definite conclu-sion about their effects on relapse and disability progression in multiple sclerosis(MS)and neuromyelitis optica spectrum disorder(NMOSD).Methods:This was a retrospective cohort study.Patients were included from four centers.Demo-graphic and clinical data were extracted from the clinical database,while data involving environmental exposures during daily life,relapse,and disability progression were obtained through telephone follow-up interviews.Determinants of re-lapse were assessed by Cox proportional models,and disability progression was assessed by linear regression.Kaplan‒Meier survival was used to estimate relapse within five years after the first attack.Results:A total of 130 MS pa-tients and 318 NMOSD patients were included in this study,and females accounted for 60%and 79.6%,respectively.MS patients with an active smoking history had a higher risk of relapse,for which the association became borderline signific-ant after accounting for covariates(aHR=1.52,95%CI=1.00,2.31;p=0.052).The relapse risk between ever-smokers who smoked more than 10 cigarettes per day and smokers who smoked less than 10 cigarettes per day was not significantly dif-ferent(aHR=0.96,95%CI=0.63,1.47;p=0.859).However,exposure to passive smoking was associated with a reduced risk of MS relapse(aHR=0.75,95%CI=0.56,1.00;p=0.044)compared with never-exposed patients.No associations were observed between active smoking/passive smoking and the risk of NMOSD relapse,but patients with a history of smoking were associated with a lower annual progression rate by Expanded Disability Status Scale(EDSS)(aβ=-0.20,95%CI=-0.38,-0.01;p=0.036)and Multiple Sclerosis Severity Score(MSSS)(aβ=-0.23,95%CI=-0.44,-0.03;p=0.028).Conclusion:Our research shows that active smoking increases the relapse risk of MS and has a negative impact on disabil-ity progression;thus,smoking cessation should be encouraged.
NETL
NSTL
万方数据
维普
