Laboratoire de Biochimie et Biologie Moléculaire, Tours, France.
UMR 1253 iBrain, Université de Tours, Inserm, Tours, France.
Eur J Neurol. 2023 Jun;30(6):1611-1618. doi: 10.1111/ene.15779. Epub 2023 Mar 23.
Forced vital capacity (FVC) remains difficult to determine for some patients suffering from amyotrophic lateral sclerosis (ALS) due to the rapid progression of the disease. Arterial blood gas (ABG) parameters could represent a valuable alternative. The aim of this study was therefore to evaluate the correlation between ABG parameters and FVC, along with the prognostic ability of ABG parameters, in a large cohort of ALS patients.
ALS patients (n=302) with FVC and ABG parameters available at diagnosis were included. Correlations between ABG parameters and FVC were evaluated. Cox regression was then carried out to determine the association of each parameter (ABG and clinical data) with survival. Finally, receiver operating characteristic (ROC) curves were built to predict the survival of ALS.
Bicarbonates (HCO ), oxygen partial pressure (pO ), carbon dioxide partial pressure (pCO ), base excess (BE), oxygen saturation and oxyhemoglobin were significantly correlated with FVC both in patients with spinal or bulbar onset. Univariate Cox regression showed that HCO and BE were associated with survival but only in spinal forms. ABG parameters predicted the survival of ALS with a similar performance to FVC, HCO being the parameter with the highest area under the curve.
Our results suggest that there is an interest in conducting a longitudinal evaluation throughout disease progression to confirm the equal performances of FVC and ABG. This study highlights the benefits of performing ABG analysis that could be used as an interesting alternative to FVC when spirometry cannot be performed.
由于疾病的快速进展，一些患有肌萎缩侧索硬化症（ALS）的患者的用力肺活量（FVC）仍然难以确定。动脉血气（ABG）参数可能是一种有价值的替代方法。因此，本研究旨在评估 ABG 参数与 FVC 之间的相关性，以及 ABG 参数在大型 ALS 患者队列中的预后能力。
纳入了诊断时具有 FVC 和 ABG 参数的 ALS 患者（n=302）。评估了 ABG 参数与 FVC 之间的相关性。然后进行 Cox 回归以确定每个参数（ABG 和临床数据）与生存的关联。最后，构建了接收者操作特征（ROC）曲线来预测 ALS 的生存情况。
在脊髓型或延髓型发病的患者中，碳酸氢盐（HCO ）、氧分压（pO ）、二氧化碳分压（pCO ）、碱剩余（BE）、氧饱和度和氧合血红蛋白均与 FVC 显著相关。单变量 Cox 回归显示 HCO 和 BE 与生存相关，但仅在脊髓型中相关。ABG 参数预测 ALS 的生存情况，与 FVC 具有相似的性能，HCO 是曲线下面积最高的参数。
我们的研究结果表明，需要在疾病进展过程中进行纵向评估，以确认 FVC 和 ABG 的同等性能，这是很有意义的。本研究强调了进行 ABG 分析的好处，当无法进行肺活量测定时，ABG 分析可能是 FVC 的一种有趣替代方法。
