| BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of adult life characterized by the involvement of upper and lower motor neurons, leading to progressive muscle weakness、atrophy、dysphagia and respiratory failure complicated with pulmonary infection until death. The mean survival of patients from symptom onset is about 3-5 years. Recently, several hematology prognostic factors of ALS have been reported by foreigners. However, there are rare researches by Chinese. Due to the different survival duration of ALS patients, and lack of an effective disease-modifying therapy, carrying out the research about the factors affecting the prognosis of ALS has important clinical significance.ObjectiveThrough a retrospective analysis of 116 cases of ALS patients with clinical data and routine hematological parameters from Qilu hospital, we will investigate the relationship between some of hematological factors and the prognosis of amyotrophic lateral sclerosis (ALS), and search for hematology markers which could predict the prognosis of patients with ALS.Patients and MethodsA total of 116 SALS patients in Qilu hospital of Shandong University with clinical diagnosis of definite or probable SALS (El Escorial revised criteria) were included from January 2007 to December 2012.Patients were followed up by phone calls until March 2015.The following clinical factors were investigated:gender、age、onset of the age、site of onset、hospital stays, BMI. And the hematology factors were collected:albumin、creatinine (sCr)、 uric acid (UA), triglyceride(TG)、cholesterol(TC)、high density lipoprotein (HDL)、 low density lipoprotein(LDL)、low density lipoprotein/high density lipoprotein(LDIVHDL). The end event was as death or tracheotomy. If patients more than observation period still has not appeared end event、lost to follow-up or accidental deaths are considered to be censored data.Survival was calculated by Kaplan-Meier method and compared with the log-rand test. For log-rank test, each hematological factor was dichotomized according to its median value. To identify a dose-response effect, these hematological factors also assessed according to their quartiles which were significant by log-rank test. Multivariable analysis was performed with the Cox proportional hazards model. A p value of<0.05 was considered statistically significant.ResultsAt the time of data analysis, the end events were observed in 105 cases of 116 patients, and 11 cases of censored data.70 males(60.3%),46 females(39.7%); age of oneset was 27 to 76 years, The mean age of disease onset of the patients was 55.1 years.34 cases (29.5%) had a bulbar onset,43 cases(37.2%) had a upper limb onset, 17 cases(14.1%) had a lower limb onset,22 cases(19.2%) had a mixture oneset.The mean survival time was 38±27.46 months. The survival increased in patients with higher levels of serum albumin-. sCr, TG, LDL/HDL or UA. Moreover, a dose-response effect was found only in sCr and TG (P<0.05). Multivariable analysis showed only sCr as an independent hematological marker affecting the prognosis of patients with ALS. In addition, the onset age and BMI are also independent risk factors for the prognosis of patients with ALS.ConclusionBlood lipid level and nutritional status are the important factors that affect the prognosis of patients with ALS, higher lipid levels is protective factor of ALS. And preliminary studies confirmed that serum sCr level can be a hematology biomarker to predict the prognosis of patients with ALS. |
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