Effect Of Lipid Metabolism To The Disease Progressive And The Survival Of ALS

Objective: The objective of our study was to evaluate whether the serum lipid levels increase in Chinese ALS(Amyotrophic lateral sclerosis) patients., to investigate the correlations between the serum lipid levels, BMI(body mass index) and the ALSFRS-R score, DPR of ALS. Beside, we investigate the relationship between BMI and the survival of ALS.Methods: In this study, a total of 42 patients with ALS and 40 age-matched control subjects were recruited from 2007 to 2014 in Tianjin First Center Hospital. All patients were diagnosed as clinically definite or clinically probable ALS patients by neurologists according the revised El-Escorial criteria. All patients and control subjects underwent the serum examinations. The basic clinical characteristic included age of onset, gender, sites of onset(limb or bulbar), symptom duration(time from onset of symptom to diagnosis), amyotrophic lateral sclerosis functional rating scale revised(ALSFRS-R), survival time(time from the onset of symptom to death), BMI and disease progression rate(DPR) were recorded by neurologists. Unpaired,independent 2- tailed Student’s t-test, Pearson correlation coefficient and Kaplan-Meier survival analysis was used for analysis by Graph Pad Prism Ver 6.04( Graph Pad software, inc.), and data expressed by mean ± SD. P < 0.05 was considered to be significant.Results:1. Compared to controls(3.89 ± 0.15, mmol/L), serum total cholesterol(TC) levels elevated in ALS(4.49 ± 0.17, mmol/L). While in the subgroups analysis showed that the serum TC levels was significantly higher just in ALS-L subgroup.2. Compared to controls(2.33 ± 0.09, mmol/L), serum low-density lipoprotein(LDL) levels elevated in ALS(2.72 ± 0.10, mmol/L). While in the subgroups analysis showed that the serum LDL levels was significantly higher just in ALS-L subgroup.3. Compared to controls(22.71 ± 0.51), BMI levels elevated in ALS(25.99 ± 0.59).In the subgroups analysis showed that the BMI levels was significantly higher in ALS-L(26.05 ± 0.70) and ALS-B(25.23 ± 1.23) subgroups.4. The correlations analysis showed increased serum TC levels had negative correlation with disease progression rate(DPR) of ALS(R= – 0.4320, p<0.05).While in the subgroups analysis showed that the negative relationship was just in ALS-L subgroup(R= – 0.5480, p<0.05).5. The correlations analysis showed increased serum LDL levels had negative correlation with DPR of ALS(R= – 0.4421, p<0.05). While in the subgroups analysis showed that the negative relationship was just in ALS-L subgroup(R= –0.3945, p<0.05).6. The correlations analysis showed increased BMI levels had negative correlation with DPR of ALS(R= –0.6153, p<0.05). In the subgroups analysis showed that the negative relationship existed in ALS-L and ALS-B subgroup.7. The correlations analysis showed increased BMI levels had positive correlation with ALSFRS-R score of ALS(R= 0.5034, p<0.05). In the subgroups analysis showed that the positive relationship existed in ALS-L and ALS-B subgroup.8. Kaplan-Meier survival analysis showed that the median survival time of BMI﹥25 subgroup was 49,he median survival time of BMI<25 subgroup was 39. And the curve of these two groups was significantly different by used the Log-rank test.Conclusion:1. Serum TC and LDL increased in ALS patients, these phenomenon illustrated that lipid metabolism was abnormal in ALS patients.2. Increased serum TC and LDL levels had negative correlations with DPR of ALS.3. BMI increased in ALS patients, this phenomenon suggested that energy metabolism was abnormal in ALS patients.4. Increased BMI levels had negative correlation with DPR and positive relationship with the ALSFRS-R score of ALS.5. The curve of BMI ﹥ 25 and BMI < 25 subgroups was significantly different.Patients in BMI﹥25 subgroup had a longer survival than BMI<25 subgroup.The result showed that BMI was a predictor of the survival of ALS patients.