López Gómez J J, Ballesteros Pomar Ma D, Vázquez Sánchez F, Vidal Casariego A, Calleja Fernández A, Cano Rodríguez I
Sección de Endocrinología y Nutrición, Complejo Asistencial de León, León, España.
Nutr Hosp. 2011 May-Jun;26(3):515-21. doi: 10.1590/S0212-16112011000300013.
Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease.
A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition.
There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38).
The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.
营养不良会影响肌萎缩侧索硬化症（ALS）患者的发病率和死亡率。营养科应尽早并定期评估这些患者，为疾病进展提供必要措施。
一项回顾性队列研究，分析了46例诊断为ALS的患者，其中21例接受了营养治疗。我们研究了年龄、发病方式、进入营养方案的日期、经皮内镜下胃造口术（PEG）的置入情况和生存期。我们进行了Breslow检验，比较接受营养方案的患者与未接受营养支持的患者，以及接受早期营养治疗的患者与延迟营养治疗的患者。
延髓型ALS患者接受营养治疗后的中位生存期有所增加（452天对55天），脊髓型ALS患者也是如此（1798天对357天）（p = 0.002）。脊髓型ALS患者开始营养治疗的中位延迟时间为557天，而延髓型ALS患者为230天。在脊髓型ALS中，在中位生存期之前进入营养方案的患者生存期从325天延长至181天（p = 0.09），而在延髓型ALS中，提前进入的患者中位生存期从435天延长至177天（p = 0.38）。
ALS患者进入营养方案可提高生存率。早期营养治疗对患者病情发展有优势。
