Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland.
Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
Neurol Sci. 2020 May;41(5):1115-1124. doi: 10.1007/s10072-019-04201-x. Epub 2020 Jan 2.
Amyotrophic lateral sclerosis (ALS) is a fatal, neurodegenerative disorder without effective treatment. Progressive dysphagia, depression, and hypermetabolism may lead to malnutrition. The aim of the present study was to analyze the potential utility of readily available, relatively inexpensive, and rapid strategy for using laboratory parameters to assess nutritional status of ALS patients.
This study included 203 patients with ALS. The analysis of inflammatory parameters: C Reactive Protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), lymphocytes number (LN), and fibrinogen concentration (FC) was followed by nutritional markers: serum concentration of albumin (ALB), prealbumin (PALB), transferrin (TRNF), and creatinine (CREA), which were correlated with demographic and clinical parameters: body mass index (BMI), ALS phenotype, disease duration, diagnosis delay, and functional and respiratory assessment.
Nearly 20% of patients had biochemical features of inflammation. Among patients without inflammation (n = 163), a decreased serum TRNF concentration was found in 84% of cases, PALB in 39%, ALB in 25%, and CREA in 53%. The median of PALB was the highest in patients with PMA (23.5 mg/dL) and the lowest in PBP (16.6 mg/dL) (p < 0.05). The CREA concentration correlated with the BMI (r = 0.25; p < 0.01), while PALB and TRNF significantly varied depending on the severity of dysphagia. Patients with dysphagia qualified to enteral nutrition showed significantly decreased concentration of PALB, triglycerides, as well as reduced forced vital capacity, BMI, and functional status.
CREA, PALB, ALB, and TNFR are easily accessible, accurate, and low-cost parameters useful in assessment of the nutritional status in ALS.
肌萎缩侧索硬化症（ALS）是一种致命的神经退行性疾病，目前尚无有效治疗方法。进行性吞咽困难、抑郁和代谢亢进可能导致营养不良。本研究的目的是分析使用实验室参数评估 ALS 患者营养状况的简便、相对便宜且快速的策略的潜在效用。
本研究纳入了 203 例 ALS 患者。对炎症参数进行分析：C 反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞计数（WBC）、淋巴细胞数（LN）和纤维蛋白原浓度（FC），随后检测营养标志物：血清白蛋白（ALB）、前白蛋白（PALB）、转铁蛋白（TRNF）和肌酐（CREA）浓度，并与人口统计学和临床参数（BMI、ALS 表型、疾病持续时间、诊断延迟以及功能和呼吸评估）相关联。
近 20%的患者存在生化炎症特征。在无炎症的患者（n=163）中，84%的患者血清 TRNF 浓度降低，39%的患者 PALB 浓度降低，25%的患者 ALB 浓度降低，53%的患者 CREA 浓度降低。PMA 患者的 PALB 中位数最高（23.5mg/dL），PBP 患者最低（16.6mg/dL）（p<0.05）。CREA 浓度与 BMI 呈正相关（r=0.25；p<0.01），而 PALB 和 TRNF 则根据吞咽困难的严重程度显著变化。有吞咽困难症状需要进行肠内营养的患者，其 PALB、甘油三酯浓度以及用力肺活量、BMI 和功能状态显著降低。
CREA、PALB、ALB 和 TNFR 是易于获得、准确且低成本的参数，可用于评估 ALS 患者的营养状况。
