'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy.
'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy.
J Neurol Neurosurg Psychiatry. 2016 Nov;87(11):1229-1233. doi: 10.1136/jnnp-2016-313793. Epub 2016 Sep 21.
To assess the prognostic influence of premorbid smoking habits and vascular risk profile on amyotrophic lateral sclerosis (ALS) phenotype and outcome in a population-based cohort of Italian patients.
A total of 650 patients with ALS from the Piemonte/Valle d'Aosta Register for ALS, incident in the 2007-2011 period, were recruited. Information about premorbid cigarette smoking habits and chronic obstructive pulmonary disease (COPD) were collected at the time of diagnosis.
Current smokers had a significantly shorter median survival (1.9 years, IQR 1.2-3.4) compared with former (2.3 years, IQR 1.5-4.2) and never smokers (2.7 years, IQR 1.8-4.6) (p=0.001). Also COPD adversely influenced patients' prognosis. Both smoking habits and CODP were retained in Cox multivariable model.
This study has demonstrated in a large population-based cohort of patients with ALS that cigarette smoking is an independent negative prognostic factor for survival, with a dose-response gradient. Its effect is not related to the presence of COPD or to respiratory status at time of diagnosis. The understanding of the mechanisms, either genetic or epigenetic, through which exogenous factors influence disease phenotype is of major importance towards a more focused approach to cure ALS.
在意大利人群的基于人群的 ALS 患者队列中，评估发病前吸烟习惯和血管风险状况对肌萎缩侧索硬化（ALS）表型和结局的预后影响。
共招募了 650 名来自皮埃蒙特/瓦莱达奥斯塔 ALS 登记处的 ALS 患者，发病时间为 2007-2011 年。在诊断时收集了发病前吸烟习惯和慢性阻塞性肺疾病（COPD）的信息。
与既往吸烟者（2.3 岁，IQR1.5-4.2）和从不吸烟者（2.7 岁，IQR1.8-4.6）相比，当前吸烟者的中位生存期明显缩短（1.9 岁，IQR1.2-3.4）（p=0.001）。此外，COPD 也对患者的预后产生不利影响。吸烟习惯和 COPD 均保留在 Cox 多变量模型中。
这项研究在一个大型基于人群的 ALS 患者队列中表明，吸烟是生存的独立负预后因素，存在剂量反应梯度。其影响与 COPD 的存在或诊断时的呼吸状况无关。了解外源性因素影响疾病表型的机制，无论是遗传还是表观遗传，对于更有针对性地治疗 ALS 非常重要。
