Nutritional status independently affects quality of life of patients with systemic immunoglobulin light-chain (AL) amyloidosis
Nutritional status independently affects quality of life of patients with systemic immunoglobulin light-chain (AL) amyloidosis
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DOI：
10.1007/s00277-011-1309-x
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发表时间：
2012-03-01
影响因子：
3.5
通讯作者：
Merlini, Giampaolo
中科院分区：
文献类型：
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作者：
Caccialanza, Riccardo;Palladini, Giovanni;Merlini, Giampaolo
营养状况是免疫球蛋白轻链淀粉样变性（AL）的独立预后因素，但其对生活质量（QoL）的影响尚不清楚。这项横断面研究的目的是调查 AL 患者诊断时营养状况与生活质量之间的关联。通过人体测量学 [体重指数、前 6 个月的无意体重减轻 (WL) 和中臂肌肉围 (MAMC)]、生物化学（血清前白蛋白）和转诊时的半定量食物摄入量，对 150 名连续活检证实的 AL 患者的营养状况进行了评估。生活质量通过医疗结果研究 36 项简短一般健康调查进行评估。 AL 门诊患者的综合身体成分总结 (PCS) 和心理成分总结 (MCS) 分别为 36.2 +/- 10.1 和 44.9 +/- 11.3（两者的 p < 0.001 与 50 的人口正常值相比）。在根据性别、年龄、东部肿瘤合作组体能状态、受累器官数量、心脏损伤严重程度、C反应蛋白、能量摄入和 WL 进行调整的多元线性回归模型中，血清前白蛋白 < 200 mg/L 和 MAMC < 10% 的 PCS 显着较低（调整后差异 3.8，95% CI 0.18-7.5，p = 0.040 和 5.3， 95% CI 2.0-8.7，p = 0.002，分别）。前 6 个月体重每减轻 1 公斤，MCS 降低 0.47（95% CI 0.18-0.75，p = 0.002）。自诊断以来，营养状况独立影响 AL 患者的生活质量。营养评估应成为 AL 患者临床评估的组成部分。在此类患者人群中进行营养支持干预试验是必要的。
Nutritional status is an independent prognostic factor in immunoglobulin light-chain amyloidosis (AL), but its influence on quality of life (QoL) is unknown. The aim of this cross-sectional study was to investigate the association between nutritional status and QoL in AL patients at diagnosis. One hundred and fifty consecutive patients with biopsy-proven AL were assessed for nutritional status by anthropometry [body mass index, unintentional weight loss (WL) in the previous 6 months and mid-arm muscle circumference (MAMC)], biochemistry (serum prealbumin), and semiquantitative food intake at referral. QoL was assessed by the Medical Outcomes Study 36-item Short Form General Health Survey. The composite physical component summary (PCS) and the mental component summary (MCS) for AL outpatients were 36.2 +/- 10.1 and 44.9 +/- 11.3, respectively (p < 0.001 for both vs the population norms of 50). In multivariate linear regression models adjusted for gender, age, Eastern Cooperative Oncology Group performance status, the number of organs involved, the severity of cardiac damage, C-reactive protein, energy intake, and WL, PCS was significantly lower for serum prealbumin < 200 mg/L and MAMC < 10th percentile (adjusted difference 3.8, 95% CI 0.18-7.5, p = 0.040 and 5.3, 95% CI 2.0-8.7, p = 0.002, respectively). MCS was decreased by 0.47 (95% CI 0.18-0.75, p = 0.002) for each kilogram of body weight lost in the previous 6 months. Nutritional status independently affects QoL in AL patients since diagnosis. Nutritional evaluation should be integral part of the clinical assessment of AL patients. Nutritional support intervention trials are warranted in such patients' population.