INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.
INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; CHU Limoges, Department of Nutrition, Limoges, France.
Clin Nutr. 2020 Oct;39(10):3112-3118. doi: 10.1016/j.clnu.2020.01.018. Epub 2020 Jan 31.
Gastrostomy is recommended in patients with Amyotrophic Lateral Sclerosis (ALS) in the presence of weight loss over 10% as compared to usual weight, repeated aspirations or meal time duration longer than 45 min. Currently, the impact of gastrostomy on survival of ALS patients is not clear.
i) to describe diagnosis factors associated with the indication for gastrostomy ii) to evaluate survival of ALS patients with gastrostomy indication according to their acceptance of feeding tube placement.
Patients with ALS were included and followed in the ALS referral centre of Limoges's teaching hospital between 2006 and 2017. Neurological, nutritional and respiratory status was assessed prospectively from diagnosis to death. Statistical analysis was performed using Mann-Whitney test, Chi tests, Cox model and multivariate logistic regression.
Two hundred and eighty-five patients were included. Among the 182 for whom gastrostomy was indicated, 63.7% accepted the placement. The median time was 7.3 months [IQR: 3.2-15.0] and 2.7 months [IQR: 0.9-5.8] respectively from diagnosis to indication and from indication to placement. Weight loss >5% significantly increased the risk of death by 17% (p < 0.0001). At time of diagnosis, bulbar onset, a loss of one point in the body mass index or on the bulbar functional scale were all positively associated with indication for gastrostomy (aOR = 10.0 [95%CI: 1.96-25.0]; p = 0.002, aOR = 1.17 [95%CI: 1.02-1.36]; p = 0.025 and aOR = 1.19 [95%CI: 1.06-1.32]; p = 0.002, respectively). However, gastrostomy placement did not have any impact on survival (aHR = 1.25 [95%CI: 0.88-1.79]; p = 0.22).
Both neurological and nutritional criteria were associated with an indication for gastrostomy at diagnosis. Gastrostomy placement had no impact on survival. The study of earlier gastrostomy placement might be of interest in further prospective studies.
在肌萎缩侧索硬化症（ALS）患者中，与基线体重相比，体重减轻超过 10%、反复误吸或进餐时间超过 45 分钟时，推荐进行胃造口术。目前，胃造口术对 ALS 患者生存的影响尚不清楚。
i）描述与胃造口术适应证相关的诊断因素；ii）根据对喂养管放置的接受程度，评估有胃造口术适应证的 ALS 患者的生存情况。
2006 年至 2017 年，在 Limoges 教学医院的 ALS 转诊中心连续纳入 ALS 患者，并对其进行前瞻性随访。从诊断到死亡，对患者的神经、营养和呼吸状况进行评估。采用 Mann-Whitney 检验、卡方检验、Cox 模型和多变量 logistic 回归进行统计学分析。
共纳入 285 例患者。其中 182 例有胃造口术适应证，63.7%的患者接受了胃造口术。从诊断到有适应证的中位时间为 7.3 个月[IQR：3.2-15.0]，从有适应证到实施胃造口术的中位时间为 2.7 个月[IQR：0.9-5.8]。体重减轻>5%会使死亡风险增加 17%（p<0.0001）。诊断时球部起病、体质指数或球部功能量表评分降低 1 分均与胃造口术适应证呈正相关（优势比[aOR]为 10.0[95%CI：1.96-25.0]；p=0.002，aOR 为 1.17[95%CI：1.02-1.36]；p=0.025，aOR 为 1.19[95%CI：1.06-1.32]；p=0.002）。然而，胃造口术的放置对生存无影响（风险比[aHR]为 1.25[95%CI：0.88-1.79]；p=0.22）。
神经和营养标准均与诊断时的胃造口术适应证相关。胃造口术的放置对生存没有影响。进一步前瞻性研究可能需要探讨更早进行胃造口术的可能性。
