| Objective Multiple sclerosis is the most common autoimmune disease involving nervous system, which happens in the young and the middle-aged mostly, higher morbidity and the decrease in the quality of life of patients. There have been many investigations about the clinical review of MS patients in other countries but little reports are mentioned in China. This investigation mainly focused on the condition of quality of life of part of MS patients in Chongqing area and the relations with the incidences of depression, anxiety and cognitive impairment, the disability, clinical and imaging features, and accordingly explore whether above mentioned factors have effects on QOL with MS patients and to make the appropriate strategies.Methods 170 cases clinical definite MS were assessed by the scales of MSQOL-54, Hamilton HAMD and HAMA, MMSE, Kurtzke EDSS and general data questionnaire of self-made and 170 cases were also examined by 1.5T MRI. These MS patients with education backgrouds above primary school and the ability of reading can correctly understand these scales and then answer. The patients which with other diseases of nerual system, deafness and other severe systematic diseases were excluded.Results1. There were significant differences between the QOL of MS patients and respective different characters, different courses of disease, smoking or no smoking, drinking or no drinking, fatigue or no fatigue and insomnia or no insomnia(P<0.05).There were no significant differences between the QOL of MS patients with different sexes, ages, education backgrounds and occupations.2. The incidences of depression, anxiety, cognitive impairment were 6.19%, 17.86%, 32.14% respectively in the acute period group(84 patients)and they were 37.21%, 31.4% and 47.67% respectively in the remitting group(86 patients). There were significant differences between QOL of MS patients with and without depression, anxiety and cognitive impairment (P<0.05).3. The incidences of depression and anxiety were significantly different from MS patients with the different characters, EDSS scores and courses of disease (P<0.05).4. The EDSS scores had a significantly negative correlation with the scores of QOL and a positive correlation with the degree of depression and anxiety.5. For MS patients with the different courses of disease and age of onset, the EDSS scores were different (P<0.05).6. The EDSS and physical health composite scores of MS patients among different clinical subtypes were significantly different(P<0.05), however, the mental composite scores of MS patients were not different (P>0.05).7. MS patients with courses of disease≤5year , there were different scores of EDSS, physical and mental health composite with different relapsing times (P<0.05).8. Among MS patients with duration >5year, there were different scores of EDSS and physical health composite with different relapsing times(P<0.05)but not different in mental health composite scores(P>0.05).9. The incidence of encephalitis misdiagnosis is 4.7% and the incidence of cerebral infarction misdiagnosis is 4.2% for MS patients of onset.10. For MS patients with≤20years the incidences of visual dysfunction, weakness, sensory dysfunction are 61.5%, 38.5%, 35.8% respectively. For MS patients with 20～40years the incidences of three symptoms above mentioned are 31.2%, 53.8%, 30.1% respectively and for MS patients with≥40years the incidences of three symptoms above mentioned are 18.8%, 54.7%, 57.85% respectively.11. Examined by 1.5T MRI the patients of spinal cord leisons, brain lesions and brain-spinal cord lesions MS were 27.1%, 50%, 22.9% respectively. The three groups had predominant differences in the incidences of depression, anxiety and cognitive impairment and had also predominant differences in the scores of EDSS and QOL(P<0.05).12. The length of spinal cord lesions were predominantly different(P<0.05)but not different in the transect of spinal cord lesions(P>0.05)among the patients with NMO,brain-spinal cord lesions and spinal cord lesions.13. The scores of EDSS and QOL were not different in the patients with different number of locations of the lesions on MRI (P>0.05).14. There was a correlation between the different clinical subtypes and the location of lesion(sr=0.5033,P<0.05). RRMS,PRMS and benign MS mainly damaged brain and the incidences were 56%, 66.7% and 83.3% respectively. PPMS mainly damaged spinal cord and the incidence was 50%. SPMS mainly damaged brain-spinal cord and the incidence was 75%.Conclusions1.The course of disease, character, smoking, drinking, fatigue and insomnia affected the QOL of patients with MS.2. The incidences of depression, anxiety and cognitive impairment of MS patients were higher, which was mainly mild and moderate. These symptoms severely affected the QOL of the patients with MS. The character, EDSS and course also affected the incidences of depression and anxiety of the patients with MS especially the patients of introversion, higher scores of EDSS and longer course.3. There was a relationship among the affective disturbance, disability and QOL. The severe affective disturbance maybe delayed recovery of neural dysfunction and vice versa, which caused the decreased QOL.4. The longer course and older age at onset caused the severer disability (EDSS scores were higher).5. There were different scores of EDSS and QOL in different clinical subtypes. The patients of PRMS and SPMS had the severest disability and the worst QOL. The patients with benign MS had the slight disability but the best QOL.6. The relapsing times influenced the scores of EDSS and QOL. The more relapsing times caused the severer disability and the worse QOL.7. MS patients of onset easily misdiagnosed as other diseases and encephalitis and cerebral infarction was particularly prevalent.8. Initial symptoms of visual impairment were frequent in adolescent MS patients, limbs weakness were frequent in middle-aged MS patients, limbs weakness and sensory disability were frequent in old age MS patients.9. There were significant differences between incidences of depression, anxiety and cognitive impairment and different scores of EDSS and QOL of the patients with the different location of the lesions. The incidences of depression were high among the patients with spinal cord lesions and brain-spinal cord lesions (37% and 36% respectively). The incidences of anxiety and cognitive impairment were higher in patients with brain-spinal cord lesions (38.5% and 53.8% respectively). The disability was the severest for the patients with spinal cord lesions, which showed the highest scores of EDSS. The QOL was the best for the patients with brain lesions.10. The length of spinal cord lesions of NMO on MRI was the longest but the transect of spinal cord lesions were not different among the patients with NMO, brain-spinal cord lesions and spinal cord lesions.11. There were no relationship between the number of locations of the lesions and the scores of EDSS and QOL. But the decrease of EDSS and QOL scores were closely related with the location of lesions.12. There were different location of lesions in the different clinical subtypes. RRMS, PRMS and benign MS mainly damaged brain. PPMS mainly damaged spinal cord. SPMS mainly damaged brain-spinal cord. |
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