Factors Affecting Energy Metabolism and Prognosis in Patients with Amyotrophic Lateral Sclerosis
Factors Affecting Energy Metabolism and Prognosis in Patients with Amyotrophic Lateral Sclerosis
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DOI：
10.1159/000518908
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发表时间：
2021-08
影响因子：
3.9
通讯作者：
M. Kurihara;S. Bamba;Shoko Yasuhara;A. Itoh;Taishi Nagao;Naoko Nakanishi;Ryutaro Nakamura;Nobuhiro Ogawa;Akihiro Kitamura;I. Yamakawa;Hyou Kim;M. Sanada;M. Urushitani;M. Sasaki
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作者：
M. Kurihara;S. Bamba;Shoko Yasuhara;A. Itoh;Taishi Nagao;Naoko Nakanishi;Ryutaro Nakamura;Nobuhiro Ogawa;Akihiro Kitamura;I. Yamakawa;Hyou Kim;M. Sanada;M. Urushitani;M. Sasaki
背景/目的：营养状况是影响肌萎缩侧索硬化（ALS）患者预后的一个因素。在这里，我们的目的是澄清与高代谢相关的因素和ALS的预测因素。方法：根据El-Escorial修订的诊断标准，对42例ALS患者（男22例，女20例）进行调查。回顾性分析了以下数据：人体测量，血液生化，疾病严重程度，基础能量消耗（BEE），静息能量消耗（REE）间接测热法，肺量测定法和生物电阻抗分析。进行单因素和多元回归分析，以检查影响REE和代谢变化（定义为REE与去脂质量[FFM]的比值）的因素。Kaplan-Meier方法用于检查与累积事件（死亡或气管造口术）发生相关的因素。结果：42例ALS患者REE明显高于BEE，提示ALS患者存在高代谢。多元回归分析显示，REE/FFM与骨骼肌指数（−3.746至−1.532，p < 0.0001）和用力肺活量百分比（%FVC）（−0.172至−0.021，p = 0.013）密切相关。此外，骨骼肌指数和%FVC都是与累积事件发生相关的显著预测因素。结论：肌萎缩侧索硬化患者能量代谢增高，呼吸状态和肌肉质量与高代谢和预后不良有关。充足的营养支持可以通过防止呼吸状态恶化和肌肉质量减少来改善ALS的结局。
Background/Aims: Nutritional status is a factor affecting prognosis in patients with amyotrophic lateral sclerosis (ALS). Here, we aimed to clarify the factors associated with hypermetabolism and the prognosticators of ALS. Methods: Forty-two inpatients (22 men, 20 women) diagnosed with ALS according to the revised El-Escorial criteria were investigated. The following data were retrospectively analyzed: anthropometric measurements, blood biochemistry, disease severity, basal energy expenditure (BEE), resting energy expenditure (REE) measured by indirect calorimetry, spirometry, and bioelectrical impedance analysis. Single and multiple regression analysis was performed to examine factors affecting REE and metabolic changes (defined as the ratio of REE to fat-free mass [FFM]). The Kaplan-Meier method was used to examine factors associated with the occurrence of cumulative events (death or tracheostomy). Results: Among the 42 inpatients, REE was significantly higher than BEE, indicating hypermetabolism in ALS. Multiple regression analysis revealed that REE/FFM is strongly associated with the skeletal muscle index (−3.746 to −1.532, p < 0.0001) and percent forced vital capacity (%FVC) (−0.172 to −0.021, p = 0.013). Moreover, both the skeletal muscle index and %FVC were significant prognosticators associated with the occurrence of cumulative events. Conclusions: Energy metabolism was elevated in ALS, and respiratory status and muscle mass were associated with the hypermetabolism and poor prognosis. Adequate nutritional support may improve outcomes in ALS by preventing deterioration of respiratory status and reduction in muscle mass.