The Relationship Between Clinical Characteristics And Survival In Amyotrophic Lateral Sclerosis And Indexes Of Glycol-Metabolism

Objective:To analyze the relationship between Hemoglobin A1c(HbA1c),fasting blood glucose(FBG)and fructosamine(FMN)levels and clinical features and survival in patients with amyotrophic lateral sclerosis(ALS).Methods:56 patients with ALS were collected from the first hospital of Shanxi Medical University from January 1,2014 to December 31,2018.We collected the clinical data and the levels of baseline HbA1 c,FBG and FMN.The survival of patients with ALS were followed up regularly to calculate the survival period.We analyzed the relationship between the baseline HbA1 c,FBG,FMN levels and the clinical features of ALS patients,including age,gender,age of onset,site of onset,course of disease,body weight and height index(BMI).KaplanMeier survival curve and Cox proportional hazards regression model were used to analyze the correlation between HbA1 c,FBG,FMN levels and the survival of ALS patients.The area under the curve(AUC)and Cut-off point of receiver operator characteristic curve(ROC)were used to analyze the predictive value of biochemical indexes to the survival of ALS patients.Results:1.56 patients with ALS were included in the analysis of the correlation between the baseline HbA1 c level and clinical features and survival prognosis.The mean HbA1 c level was 5.65 ± 0.81%.There was no correlation between HbA1 c level and the clinical features of ALS patients,including age,gender,course of disease,site of onset,age of onset,BMI.Survival analysis showed that there was a 71.68% increase in risk of death in patients with a higher level of HbA1 c group(> 5.65%)compared with patients with a lower level of HbA1 c group(< 5.65%)(HR = 2.832,95% CI :1.125-7.128,P = 0.027).2.39 patients with ALS were included in the analysis of the correlation between the baseline FBG level and clinical features and survival prognosis.The mean FBG level was 5.15±1.31 mmol/L.There was no correlation between FBG level and clinical features of ALS patients,including age,gender,age of onset,BMI,course of disease,site of onset.Survival analysis showed that FBG level was not an independent prognostic factor for patients with ALS.3.38 patients with ALS were included in the analysis of the correlation between the baseline FMN level and clinical features and survival prognosis.The mean FMN level was 231±36 umol/L.The FMN level was not significantly correlated with the age,gender,site of age,site of onset,course of disease,BMI in patients with ALS.There was a 74.29% increase in risk of death in patients with a higher level of FMN group(> 231umol/L)compared with patients with a lower level of HbA1 c group(231umol/L)in survival analysis.(HR=2.571,95%CI: 1.018-6.491,P=0.046).4.The area under ROC curve of HbA1 c was 0.843(AUC = 0.843,95% CI : 0.716,-0.969,P < 0.0001),the Cut-off point was 0.34,the sensitivity of predicting survival of ALS patients was 65%,the specificity was 100%.The area under ROC curve of FMN was 0.704(AUC = 0.704,95% CI : 0.532-0.969,cut off value was 0.46,the sensitivity of predicting survival of ALS patients was 65%,the specificity was 82.4%.Conclusion:1.The HbA1 c,FBG and FMN levels in ALS patients had no significant correlation with age,gender,onset site,age of onset,course of disease and BMI;2.The survival time of patients with lower level of HbA1 c was better than that of patients with higher level of HbA1 c,suggesting that high HbA1 c level was a risk factor for survival and prognosis of ALS patients;The higher level of FMN was a risk factor for survival of ALS,FBG level had no correlation with the survival and prognosis of patients with ALS;3.HbA1 and FMN levels had a high clinical predictive value for the survival of patients with ALS.