Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Sci Rep. 2021 Oct 4;11(1):19682. doi: 10.1038/s41598-021-98990-x.
Few studies have investigated the factors associated with assisted ventilation use in amyotrophic lateral sclerosis (ALS) in western countries with a relatively small number of participants. This study aimed to evaluate the factors associated with assisted ventilation use using a large nationwide cohort covering the entire Korean population. We selected patients with primary or secondary diagnoses of ALS (ICD-10 code: G12.21) and a registration code for ALS (V123) in the rare intractable disease registration program. Covariates included in the analyses were age, sex, socioeconomic status and medical condition. Factors associated with non-invasive ventilation (NIV) and tracheostomy invasive ventilation (TIV) were evaluated. Logistic regression analyses were performed using odds ratios and 95% confidence intervals. In total, 3057 patients with ALS were enrolled. During the 6-year follow-up period, 1228 (40%) patients started using assisted ventilation: 956 with NIV and 272 with TIV. There was no significant difference in the assisted ventilation use according to sex, whereas different patterns of discrepancies were noted between the sexes: Females living in non-metropolitan areas showed decreased use of assisted ventilation, whereas high income levels showed a positive relationship with assisted ventilation use only in males. Patients aged ≥ 70 years showed decreased use of NIV. NIV use was more affected by socioeconomic status than TIV, whereas TIV showed a significant relationship with medical conditions such as nasogastric tube insertion and gastrostomy. We found that various factors, including age, socioeconomic status, and medical condition, were related with assisted ventilation use. Understanding the pattern of assisted ventilation use would help set optimal management strategies in patients with ALS.
很少有研究调查西方国家肌萎缩侧索硬化症（ALS）中与辅助通气使用相关的因素，这些研究的参与者相对较少。本研究旨在使用涵盖整个韩国人口的大型全国队列评估与辅助通气使用相关的因素。我们从罕见难治性疾病登记计划中选择了原发性或继发性 ALS（ICD-10 编码：G12.21）和 ALS 登记码（V123）的患者。纳入分析的协变量包括年龄、性别、社会经济地位和医疗状况。评估了与无创通气（NIV）和气管切开术有创通气（TIV）相关的因素。使用比值比和 95%置信区间进行逻辑回归分析。共纳入 3057 例 ALS 患者。在 6 年的随访期间，1228 例（40%）患者开始使用辅助通气：956 例使用 NIV，272 例使用 TIV。性别与辅助通气使用无显著差异，而性别之间存在差异模式：非大都市地区的女性辅助通气使用率较低，而高收入水平仅与男性的辅助通气使用呈正相关。年龄≥70 岁的患者 NIV 使用减少。NIV 使用受社会经济地位的影响大于 TIV，而 TIV 与鼻胃管插入和胃造口术等医疗条件有显著关系。我们发现，包括年龄、社会经济地位和医疗状况在内的各种因素与辅助通气使用有关。了解辅助通气使用模式有助于为 ALS 患者制定最佳管理策略。
