Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan.
Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Acta Neurol Scand. 2022 Nov;146(5):578-585. doi: 10.1111/ane.13683. Epub 2022 Aug 16.
Forced vital capacity (FVC) is recommended as a respiratory function test in patients with amyotrophic lateral sclerosis (ALS). However, in ALS associated with orofacial palsy, FVC may be an unreliable test. Slow vital capacity (SVC) is an easier and more reliable test even in cases with bulbar symptoms. However, it remains unclear whether respiratory function tests using SVC and FVC are associated with prognosis after percutaneous endoscopic gastrostomy (PEG) placement. This study aimed to confirm whether both SVC and FVC are related to prognosis after PEG placement in patients with ALS.
We conducted this retrospective observational cohort study of 69 consecutive patients diagnosed with sporadic ALS who underwent PEG placement between July 2007 and February 2020. We analyzed the association with mortality 6 months after PEG placement and evaluated long-term prognosis.
Forty-four patients met the inclusion criteria. In cases with decreased SVC (p < .01) and FVC (p < .01), a significant difference was observed in mortality 6 months after PEG placement, with an optimal cut-off of SVC ≤57.4% (sensitivity, 0.828; specificity, 0.867) and FVC ≤57.3% (sensitivity, 0.828; specificity, 0.867). Multivariate analysis showed that onset age ≥ 65 years (p < .05), SVC ≤57.4% (p < .01), and FVC ≤57.3% (p < .01) were associated with survival after PEG placement.
SVC, like FVC, is an important prognostic factor after PEG placement in patients with ALS, and there is a possibility that evaluation using SVC can complement respiratory function testing even in cases where the evaluation of FVC is limited.
用力肺活量（FVC）被推荐作为肌萎缩侧索硬化症（ALS）患者的呼吸功能测试。然而，在伴有口面肌无力的 ALS 患者中，FVC 可能是一项不可靠的测试。慢肺活量（SVC）是一项更简单、更可靠的测试，即使在延髓症状的情况下也是如此。然而，使用 SVC 和 FVC 的呼吸功能测试是否与经皮内镜下胃造瘘术（PEG）后预后相关仍不清楚。本研究旨在证实 SVC 和 FVC 是否与 ALS 患者 PEG 后预后相关。
我们对 2007 年 7 月至 2020 年 2 月间接受 PEG 治疗的 69 例散发性 ALS 连续患者进行了这项回顾性观察队列研究。我们分析了与 PEG 后 6 个月死亡率的相关性，并评估了长期预后。
44 例患者符合纳入标准。在 SVC（p<0.01）和 FVC（p<0.01）降低的情况下，PEG 后 6 个月死亡率有显著差异，SVC≤57.4%（灵敏度为 0.828，特异性为 0.867）和 FVC≤57.3%（灵敏度为 0.828，特异性为 0.867）为最佳截断值。多变量分析显示，发病年龄≥65 岁（p<0.05）、SVC≤57.4%（p<0.01）和 FVC≤57.3%（p<0.01）与 PEG 后生存相关。
SVC 与 FVC 一样，是 ALS 患者 PEG 后重要的预后因素，即使在 FVC 评估有限的情况下，使用 SVC 进行评估也有可能补充呼吸功能测试。
