Department of Neurology, West China Hospital, Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, China.
Department of Nutritional Science, The Pennsylvania State University, 109 Chandlee Lab, University Park, PA, 16802, USA.
Mol Neurodegener. 2017 Sep 21;12(1):69. doi: 10.1186/s13024-017-0211-y.
There are inconsistences regarding the correlation between diabetes or fasting blood glucose concentrations and the risk and survival of amyotrophic lateral sclerosis (ALS) in the previous studies. Moreover, the association between hemoglobin A1c (HbA1c) levels, which reflect long-term glycemic status, and ALS survival was not examined.
A prospective cohort study including 450 Chinese sporadic ALS patients (254 men and 196 women; mean age: 55.4 y). We identified 223 deaths during average 1.6 years of follow-up. We assessed levels of fasting HbA1c (primary exposure) and glucose (secondary exposure) via ion exchange high-performance liquid chromatography and hexokinase/glucose-6-pgosphate dehydrogenase methods, respectively. Multivariate Cox proportional hazards regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of ALS mortality across the exposures.
Our results indicated that, higher levels of HbA1c, but not fasting blood glucose concentrations, were significantly associated with higher risks of mortality. The adjusted HR was 1.40 (95% confidence interval (95% CI): 1.02-1.99) for HbA1c of 5.7-6.4%, and 2.06 (95% CI: 1.07-3.96) for HbA1c ≥6.5%, relative to HbA1c <5.7% (P trend =0.01), after adjustment for age, smoking, obesity, disease severity, site of onset, lifestyle, and other potential confounders. The adjusted HR was 1.38 (95% CI: 0.81-2.35, P trend =0.13) for fasting glucose concentrations ≥7.0 mmol/L vs <5.6 mmol/L. We did not observe any significant interactions between HbA1c levels and age, sex, smoking, body mass index, rate of disease progression of ALS, and site of onset (P-interactions >0.05 for all).
In this prospective study, we observed that individuals with higher HbA1c levels at the baseline had higher risk of mortality, which is independent of other known risk factors.
先前的研究中，糖尿病或空腹血糖浓度与肌萎缩侧索硬化症（ALS）的风险和生存之间的相关性存在不一致之处。此外，反映长期血糖状况的糖化血红蛋白（HbA1c）水平与 ALS 生存之间的关系尚未被研究。
本前瞻性队列研究纳入了 450 名中国散发性 ALS 患者（254 名男性，196 名女性；平均年龄：55.4 岁）。在平均 1.6 年的随访期间，我们共确定了 223 例死亡。我们采用离子交换高效液相色谱法和己糖激酶/葡萄糖-6-磷酸脱氢酶法分别检测空腹 HbA1c（主要暴露）和血糖（次要暴露）的水平。多变量 Cox 比例风险回归模型用于计算暴露水平下 ALS 死亡率的风险比（HR）和 95%置信区间（95%CI）。
我们的结果表明，较高的 HbA1c 水平，但不是空腹血糖浓度，与较高的死亡率风险显著相关。HbA1c 为 5.7%-6.4%、HbA1c ≥6.5%的调整 HR 分别为 1.40（95%CI：1.02-1.99）和 2.06（95%CI：1.07-3.96），与 HbA1c <5.7%相比（P 趋势=0.01），调整年龄、吸烟、肥胖、疾病严重程度、发病部位、生活方式和其他潜在混杂因素后。空腹血糖浓度≥7.0mmol/L 与<5.6mmol/L 相比的调整 HR 为 1.38（95%CI：0.81-2.35，P 趋势=0.13）。我们没有观察到 HbA1c 水平与年龄、性别、吸烟、体重指数、ALS 疾病进展率和发病部位之间存在任何显著的交互作用（所有 P 交互值>0.05）。
在这项前瞻性研究中，我们观察到基线时 HbA1c 水平较高的个体死亡率风险较高，这独立于其他已知的危险因素。
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