Department of Neurology, University of Ulm, Ulm, Germany.
Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
Eur J Neurol. 2020 Aug;27(8):1405-1414. doi: 10.1111/ene.14300. Epub 2020 Jun 2.
A wide variety of metabolic changes, including an increased incidence of diabetes mellitus (DM) and dyslipidaemia, has been described in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the associations of statin use and history of DM with onset of disease and survival in patients with ALS.
In all, 501 patients (mean age 65.2 ± 10.9 years; 58.5% male) from the ALS Registry Swabia recruited between October 2010 and April 2016 were included in this prospective cohort study. Data were collected using a standardized questionnaire.
Statin use (n = 65) was not associated with overall survival (P = 0.62). Age of ALS onset in patients with DM was 4.2 years later (95% confidence interval 1.3-7.2 years) than in patients without DM (P < 0.01). The overall survival of patients with high body mass index at study entry (>27.0 kg/m , upper quartile, n = 127) was prolonged by more than 5 months compared to patients with low body mass index (<22.0 kg/m , lower quartile, n = 123; P = 0.04).
This study supports the view that statin use is not associated with overall survival of ALS patients, suggesting that statins are not harmful and should not be discontinued in ALS. Furthermore, the delayed onset of ALS in patients with DM may mirror the potentially protective metabolic profile associated with type 2 DM. Consistently, this study provides further evidence that high body mass index is a positive prognostic factor in ALS.
肌萎缩侧索硬化症（ALS）患者存在多种代谢变化，包括糖尿病（DM）和血脂异常的发病率增加。本研究旨在探讨他汀类药物的使用和 DM 史与 ALS 患者发病和生存的相关性。
本前瞻性队列研究共纳入了 2010 年 10 月至 2016 年 4 月间在 ALS 注册中心 Swabia 招募的 501 例患者（平均年龄 65.2±10.9 岁，58.5%为男性）。通过标准化问卷收集数据。
他汀类药物的使用（n=65）与总生存期无关（P=0.62）。患有 DM 的患者 ALS 发病年龄比无 DM 患者晚 4.2 岁（95%置信区间为 1.3-7.2 岁，P<0.01）。在研究入组时体质量指数较高（>27.0kg/m2，上四分位数，n=127）的患者的总体生存期比体质量指数较低（<22.0kg/m2，下四分位数，n=123）的患者延长了超过 5 个月（P=0.04）。
本研究支持他汀类药物的使用与 ALS 患者的总体生存率无关的观点，表明他汀类药物不会造成伤害，不应在 ALS 中停用。此外，DM 患者 ALS 发病延迟可能反映了与 2 型 DM 相关的潜在保护性代谢特征。一致地，本研究进一步提供了证据表明高体质量指数是 ALS 的一个正预后因素。
