Associations of Patient Mood, Modulators of Quality of Life, and Pharmaceuticals with Amyotrophic Lateral Sclerosis Survival Duration
Associations of Patient Mood, Modulators of Quality of Life, and Pharmaceuticals with Amyotrophic Lateral Sclerosis Survival Duration
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DOI：
10.3390/bs10010033
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发表时间：
2020-01-01
影响因子：
2.6
通讯作者：
Mitchell, Cassie S.
中科院分区：
文献类型：
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作者：
Bond, Leila;Bowen, Gloria;Mitchell, Cassie S.
在致命的运动神经元病-肌萎缩侧索硬化症中，评估了生活质量调节因子(QOL)和生存时间的相关性。主要类别包括临床情绪印象(CIM)；身体健康；患者社会支持；以及干预措施、药物和补充剂的使用。使用适用的方法(卡方检验、t检验、单因素方差分析、逻辑回归、随机森林、费舍尔精确检验)，在1585名患者的回溯性队列中，在p<；0.05和p<；0.001显著阈值下对相关性进行评估。与积极(快乐或正常)情绪显著相关的因素包括家庭支持、使用双水平气道正压(BiPAP)和/或辅助咳嗽。躯体因素的下降，如吞咽困难、流口水、全身疼痛以及ALSFRS-R总分或用力肺活量(FVC)的下降，与负面(抑郁或焦虑)情绪显著相关(p<；0.05)。抗抑郁药或止痛药的使用与肌萎缩侧索硬化症患者的情绪无关(p>；0.05)，但与生存期的增加显著相关(p<；0.05)。积极的患者情绪、双向正压、辅助咳嗽、经皮内窥镜胃造口术(聚乙二醇法)和伴随临床就诊与延长存活期相关(p<；0.001)。在47种最流行的药物和补充剂类别中，有17种与存活期显著延长有关，延长时间从+4.5个月到+16.5个月不等。三环类抗抑郁药、非阿片类药物、肌肉松弛药和维生素E的联合生存期增加最多(p<；0.05)。随机森林研究了复杂的相互作用，发现以下药物和补充剂最能预测生存时间：维生素A、复合维生素、聚乙二醇补充剂、替代草药、抗组胺药、肌肉松弛药、兴奋剂泻药和抗痉挛药。他汀类药物、二甲双胍和噻嗪类利尿剂与存活率下降的相关性不显著。
Associations of modulators of quality of life (QoL) and survival duration are assessed in the fatal motor neuron disease, Amyotrophic Lateral Sclerosis. Major categories include clinical impression of mood (CIM); physical health; patient social support; and usage of interventions, pharmaceuticals, and supplements. Associations were assessed at p < 0.05 and p < 0.001 significance thresholds using applicable methods (Chi-square, t-test, ANOVA, logistical regression, random forests, Fisher's exact test) within a retrospective cohort of 1585 patients. Factors significantly correlated with positive (happy or normal) mood included family support and usage of bi-level positive airway pressure (Bi-PAP) and/or cough assist. Decline in physical factors like presence of dysphagia, drooling, general pain, and decrease in ALSFRS-R total score or forced vital capacity (FVC) significantly correlated with negative (depressed or anxious) mood (p < 0.05). Use of antidepressants or pain medications had no association with ALS patient mood (p > 0.05), but were significantly associated with increased survival (p < 0.05). Positive patient mood, Bi-PAP, cough assist, percutaneous endoscopic gastrostomy (PEG), and accompaniment to clinic visits associated with increased survival duration (p < 0.001). Of the 47 most prevalent pharmaceutical and supplement categories, 17 associated with significant survival duration increases ranging +4.5 to +16.5 months. Tricyclic antidepressants, non-opioids, muscle relaxants, and vitamin E had the highest associative increases in survival duration (p < 0.05). Random forests, which examined complex interactions, identified the following pharmaceuticals and supplements as most predictive to survival duration: Vitamin A, multivitamin, PEG supplements, alternative herbs, antihistamines, muscle relaxants, stimulant laxatives, and antispastics. Statins, metformin, and thiazide diuretics had insignificant associations with decreased survival.