Department of Neurology, Ulm University Hospital, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
J Neurol. 2023 Jun;270(6):3082-3090. doi: 10.1007/s00415-023-11630-4. Epub 2023 Feb 28.
To date, the role of blood lipid levels and their association with the onset and prognosis of ALS is controversial. We explored these associations in a large, population-based case-control study.
Between October 2010 and June 2014, 336 ALS patients (mean age 65.7 ± 10.7; 57.7% male) and 487 sex- and age-matched controls from the same geographic region were recruited within the ALS registry in Southwest Germany. Triglycerides and cholesterol (high-density lipoprotein (HDL), low-density lipoprotein (LDL), total) were measured. The ALS cohort was followed up for vital status. Conditional logistic regression models were applied to calculate odds ratio (OR) for risk of ALS associated with serum lipid concentrations. In ALS patients only, survival models were used to appraise the prognostic value.
High concentration of total cholesterol (OR 1.60, 95% confidence interval (CI) 1.03-2.49, top vs. bottom quartile), but not HDL, LDL, LDL-HDL ratio, or triglycerides, was positively associated with the risk of ALS. During the median follow-up time of 88.9 months, 291 deaths occurred among 336 ALS patients. In the adjusted survival analysis, higher HDL (HR 1.72, 95% CI 1.19-2.50) and LDL cholesterol levels (HR 1.58, 95% CI 1.11-2.26) were associated with higher mortality in ALS patients. In contrast, higher triglyceride levels were associated with lower mortality (HR 0.68, 95% CI 0.48-0.96).
The results highlight the importance to distinguish cholesterol from triglycerides when considering the prognostic role of lipid metabolism in ALS. It further strengthens the rationale for a triglyceride-rich diet, while the negative impact of cholesterol must be further explored.
迄今为止，血脂水平及其与 ALS 发病和预后的关系仍存在争议。我们在一项大型基于人群的病例对照研究中探讨了这些关联。
2010 年 10 月至 2014 年 6 月，在德国西南部的 ALS 注册处招募了 336 名 ALS 患者（平均年龄 65.7±10.7；57.7%为男性）和 487 名性别和年龄匹配的对照者。测量了甘油三酯和胆固醇（高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、总胆固醇）。对 ALS 队列进行了随访以确定生存状态。应用条件逻辑回归模型计算血清脂质浓度与 ALS 风险相关的优势比（OR）。仅在 ALS 患者中，使用生存模型评估预后价值。
总胆固醇浓度较高（OR 1.60，95%置信区间（CI）1.03-2.49，最高与最低四分位数相比），而 HDL、LDL、LDL-HDL 比值或甘油三酯与 ALS 风险无相关性。在 336 名 ALS 患者的中位随访时间 88.9 个月期间，有 291 名患者死亡。在调整后的生存分析中，较高的 HDL（HR 1.72，95%CI 1.19-2.50）和 LDL 胆固醇水平（HR 1.58，95%CI 1.11-2.26）与 ALS 患者的死亡率较高相关。相比之下，较高的甘油三酯水平与较低的死亡率相关（HR 0.68，95%CI 0.48-0.96）。
研究结果强调在考虑脂质代谢在 ALS 中的预后作用时，区分胆固醇和甘油三酯的重要性。这进一步加强了富含甘油三酯饮食的合理性，而胆固醇的负面影响则需要进一步探讨。
