| Abstract | Cilj istraživanja:
Cilj ovog istraživanja je provjeriti koliko je bilo novodijagnosticiranih slučajeva multiple skleroze na Klinici za neurologiju KBC-a Split u razdoblju od 2009. do 2014. godine, dobiti uvid u osnovne epidemiološke i kliničke značajke njihove bolesti te analizirati dobivene rezultate uspoređujući ih s rezultatima i zaključcima drugih svjetskih istraživanja.
Materijal i metode:
Uzorak potreban za provedbu istraživanja dobiven je retrospektivnim pregledom arhive Klinike za neurologiju KBC-a Split u potrazi za medicinskom dokumentacijom svih pacijenata hospitaliziranih na klinici u razdoblju od 1. siječnja 2009. do 31. prosinca 2014. godine. Kriteriji uvrštavanja bili su da su pacijenti hospitalizirani u navedenom razdoblju te im je tada prvi put postavljena dijagnoza multiple skleroze. Ulazni podaci za statističku obradu bili su: dob pri dijagnozi, spol, trajanje simptoma prije postavljanja dijagnoze, pozitivna obiteljska anamneza na malignome, multiplu sklerozu, bolesti štitnjače i/ili autoimune bolesti, pozitivna osobna anamneza na malignome, bolesti štitnjače, depresiju, dijabetes i/ili autoimune bolesti, simptomi pacijenata otkriveni anamnestički, simptomi pacijenata otkriveni u neurološkom statusu pri hospitalizaciji, EDSS rezultat i pušenje.
Rezultati:
U razdoblju 2009. - 2014. godine u Klinici za neurologiju KBC-a Split dijagnosticirano je 202 novih slučajeva multiple skleroze, učestalije kod žena i to u omjeru 2,96:1. Prosječna dob bila je 37,93 (SD 11,12) godina. Većina pacijenata je bila stara između 20 i 40 godina (55,45%), a pacijenti mlađi od 20 godina (4,95%) i stariji od 60 godina (4,45%) su bili vrlo rijetki. Na temelju skupine od 168 pacijenta koji su imali podatak o trajanju simptoma izračunali smo prosječno vrijeme od nastupa prvih simptoma do konačne dijagnoze multiple skleroze, a iznosi 16,87 mjeseci. Medijan trajanja simptoma je bio 3,25 mjeseci što znači da je 50% pacijenata dijagnosticirano unutar 3,25 mjeseci od nastupa simptoma. Većina pacijenata (77,38%) je bilo dijagnosticirano unutar 12 mjeseci od nastupa simptoma indikativnih za multiplu sklerozu. U obiteljskoj anamnezi pacijenata većinom smo zabilježili pojavu malignoma (28,22%) nakon čega se najčešće bilježila pojava multipe skleroze (5,45%). Od ostalih zabilježili smo još pojavu autoimunih bolesti (3,47%) i bolesti štitnjače (2,97%). U osobnoj anamnezi pacijenata zabilježili smo pojavu bolesti koje su nam bile od interesa kod njih 15,84%. Najčešće su to bile bolesti štitnjače koje smo zabilježili kod 10,89% pacijenata. U manjem broju su se još pojavljivali malignomi, depresija i dijabetes. Od simptoma koje su osjećali pacijenti su dominantno opisivali poteškoće s motoričkim (47,03%) i osjetnim (47,03%) sustavom. Također su jedni od češće opisivanih simptoma bili vidni simptomi (36,63%) i simptomi moždanog debla (22,77%). Nešto rjeđe pacijenti su opisivali glavobolje (15,84%), poremećaje sfinktera (15,35%) i cerebelarne simptome (11,88%). Od ostalih simptoma zapaženi su još umor, vrtoglavica, bol, smetnje koncentracije i pamćenja. Pri kliničkom pregledu pacijenata u statusu su najčešće zapaženi motorički (68,32%), cerebelarni (44,55%) i osjetni simptomi (42,57%). Zabilježeni su još simptomi moždanog debla, vidni simptomi i poremećaji sfinktera, a čak 16,83% pacijenata je pri hospitalizaciji bilo urednog statusa. Pri hospitalizaciji većina pacijenata imala je EDSS rezultat od 0 do 1 (51,49%). Rezultat od 1,5 do 4 imalo je 40,59% pacijenata, a samo 7,92% pacijenata imalo je EDSS rezultat veći od 4. Udio pušača među novodijagnosticiranim pacijentima bio je 37,62%, a 4,95% je nekoć pušilo.
Zaključak:
U šestogodišnjem razdoblju 2009. - 2014. godine u Klinici za neurologiju KBC-a Split dijagnosticirano je 202 novih slučajeva multiple skleroze. Gotovo trostruko češće je bolest dijagnosticirana kod osoba ženskog spol što smatramo da je u skladu s trendom porasta tog omjera u posljednjim desetljećima. Prosječna dob pri dijagnozi je bila 37,93 godine, a većina je pacijenta imala između 20 i 40 godina (55,45%). Prosječno vrijeme trajanja simptoma indikativnih za multiplu sklerozu prije postavljanja dijagnoze je bilo 16,87 mjeseci, međutim daljnjom analizom podataka utvrđeno je da je 77,38% pacijenata dijagnosticirano unutar 12 mjeseci od početka simptoma. Kod otprilike 1/3 pacijenata (35,64%) u obiteljskoj anamnezi zabilježena je pojava nekih bolesti za koje svjetska literatura pokazuje korelaciju s multiplom sklerozom. Najčešće su to bili malignomi, dok je multipla skleroza zabilježena u relativno malih 5,45%. 15,84% pacijenata ima zabilježeno pojavu nekakve bolesti uz multiplu sklerozu, od čega je najviše bilo bolesti štitnjače (10,89%). Što se tiče kliničke slike novodijagnosticiranih pacijenata, ona je najčešće bila obilježena pojavom motoričkih i osjetnih ispada. Očekivano većina pacijenata kod kojih je tek postavljena dijagnoza multiple skleroze nije imala visok EDSS rezultat, te su pacijenti bili većinom bez simptoma ili s minimalnim ispadima. Od novodijagnosticiranih pacijenata u razdoblju 2009. - 2014. 37,62% su bili pušači što je udio pušača za otprilike 10% veći nego u općoj populaciji. |
| Abstract (english) | Objectives:
The aim of this study is to verify how many cases of newly diagnosed multiple sclerosis was there in the Clinic of Neurology in KBC Split in the period from the year 2009 to 2014, to get the insight in the basic epidemiological and clinical features of their disease and to analyze the results we get by comparing them with results and conclusions from other world researches.
Patients and Methods
The sample needed for the implementation of our research was obtained by retrospective inspection of the Clinic of neurology archive in KBC Split in search of medical documentation of all the patients hospitalized in the clinic from January 1st 2009 to December 31st 2014. The criteria of inclusion were that the patients were hospitalized in the aforementioned period and that they were then diagnosed with multiple sclerosis for the first time. Data for statistical analysis were: age at diagnosis, gender, duration of symptoms before diagnosis, positive family history for malignancies, multiple sclerosis, thyroid diseases and/or autoimmune diseases, positive personal history for malignancies, thyroid diseases, depression, diabetes and/or autoimmune diseases, patient symptoms discovered anamnestically, patient symptoms discovered in neurological status at hospitalization, EDSS score and smoking.
Results:
In the period 2009 - 2014 in the Clinic of neurology of KBC Split 202 new cases of multiple sclerosis were diagnosed, more frequently in women in a rate of 2,96:1. Average age was 37,93 (SD 11,12) years. Most of the patients were between 20 and 40 years old (55,45%) and patients younger than 20 (4,95%) and older than 60 (4,45%) were very rare. Based on a group of 168 patients who had data of symptom duration we calculated the average time of first symptom onset to final diagnosis of multiple sclerosis and it was 16,87 months. The median of symptom duration was 3,25 months which means that 50% of patients were diagnosed within 3,25 months from symptom onset. Most of the patients (77,38%) were diagnosed within 12 months of symptoms indicative for multiple sclerosis onset. In patients family history we mostly noted malignancies (28,22%) after which multiple sclerosis (5,45%) was most frequently noted. Of the rest we noted autoimmune diseases (3,47%) and thyroid diseases (2,97%). In patients personal history we noted appearance of disease of interest in 15,84% of them. Most often those were thyroid diseases which we noted in 10,89% of patients. In smaller number appeared malignancies, depression and diabetes. Of the symptoms that they had patients dominantly described difficulties with motor (47,03%) and sensory (47,03%) system. Also more often described symptoms were visual (36,63%) and brainstem (22,77%) symptoms. Slightly rarely patients desribed headaches (15,84%), bowel/bladder (15,35%) and cerebellar (11,88%) symptoms. Of other symptoms fatigue, vertigo, pain, concentration and memory problems were noted. At clinical examination of patients in status most frequently noticed were motor (68,32%), cerebellar (44,55%) and sensory (42,57%) symptoms. Also noted were brainstem, visual and bowel/bladder symptoms and even 16,83% of patients had a normal status at hospitalization. At hospitalization most of the patients had an EDSS score of 0-1 (51,49%). EDSS score 1,5-4 had 40,59% of patients and only 7,92% of patients had an EDSS score higher than 4. The rate of smokers among newly diagnosed patients was 37,62% and 4,95% used to smoke.
Conclusion:
In the six year period 2009 - 2014 in the Clinic of neurology of KBC Split 202 new cases of multiple sclerosis were diagnosed. Almost three times more often the disease was diagnosed in women what we consider to be in accordance with the trend of that rate's increase in the last decades. Average age at diagnosis was 37,93 years and most of the patients were between 20 and 40 years old (55,45%). Average duration of symptoms indicative for multiple sclerosis before diagnosis was 16,87 months, but with further analysis of data it was established that 77,38% of patients were diagnosed within 12 months of symptom onset. At around 1/3 of patients (35,64%) in their family history an appearance of some diseases that world literature shows correlation to multiple sclerosis has been noted. Most often those were malignancies, while multiple sclerosis was noted in relatively little 5,45%. 15,84% of patients had some kind of disease along multiple sclerosis noted, of which thyroid disease (10,89%) were the most. About the clinical presentation of newly diagnosed patients, it was most often marked by appearance of motor and sensory deficit. As expected most of the patients which were just diagnosed with multiple sclerosis didn't have a high EDSS score and patients were mostly without symptoms or with minimum deficit. Of newly diagnosed patients in the period 2009 - 2014. 37,62% were smokers which is a rate about 10% higher than in the general population. |
