Bond Leila, Ganguly Paulamy, Khamankar Nishad, Mallet Nolan, Bowen Gloria, Green Braden, Mitchell Cassie S
Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA.
Brain Sci. 2019 Sep 4;9(9):223. doi: 10.3390/brainsci9090223.
There is literature discord regarding the impact of percutaneous endoscopic gastrostomy (PEG), or "feeding tube", on amyotrophic lateral sclerosis (ALS) outcomes. We assess one of the largest retrospective ALS cohorts to date (278 PEG users, 679 non-users). Kruskal-Wallis and Kaplan-Meier analysis compared cohort medians and survival duration trends. A meta-analysis determined the aggregate associative effect of PEG on survival duration by combining primary results with 7 published studies. Primary results ( < 0.001) and meta-analysis ( < 0.05) showed PEG usage is associated with an overall significant increase in ALS survival duration, regardless of onset type. Percent predicted forced vital capacity (FVC %predict) ≥50 at PEG insertion significantly increases survival duration ( < 0.001); FVC %predict ≥60 has the largest associative benefit (+6.7 months, < 0.05). Time elapsed from ALS onset until PEG placement is not predictive ( > 0.05). ALSFRS-R survey assessment illustrates PEG usage does not slow functional ALS pathology ( > 0.05), but does stabilize weight and/or body mass index (BMI) ( < 0.05). Observed clinical impression of mood (CIM), was not impacted by PEG usage ( > 0.05). Overall results support PEG as a palliative intervention for ALS patients with ≥50 FVC %predict at PEG insertion.
关于经皮内镜下胃造口术（PEG），即“饲管”，对肌萎缩侧索硬化症（ALS）预后的影响，文献中存在分歧。我们评估了迄今为止最大的回顾性ALS队列之一（278名PEG使用者，679名非使用者）。Kruskal-Wallis和Kaplan-Meier分析比较了队列中位数和生存时间趋势。一项荟萃分析通过将主要结果与7项已发表研究相结合，确定了PEG对生存时间的总体关联效应。主要结果（<0.001）和荟萃分析（<0.05）表明，无论发病类型如何，使用PEG都与ALS生存时间的总体显著增加相关。PEG插入时预测的用力肺活量百分比（FVC %预测值）≥50可显著延长生存时间（<0.001）；FVC %预测值≥60具有最大的关联益处（延长6.7个月，<0.05）。从ALS发病到PEG置入的时间没有预测性（>0.05）。ALS功能评分量表修订版（ALSFRS-R）调查评估表明，使用PEG不会减缓ALS的功能病理进展（>0.05），但会稳定体重和/或体重指数（BMI）（<0.05）。观察到的情绪临床印象（CIM）不受PEG使用的影响（>0.05）。总体结果支持将PEG作为PEG插入时FVC %预测值≥50的ALS患者的姑息性干预措施。
