Sousa-Catita Diogo, Mascarenhas Paulo, Oliveira Cátia, Grunho Miguel, Santos Carla A, Cabrita João, Correia Paula, Fonseca Jorge
Aging Lab, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal.
Residências Montepio, Serviços de Saúde, SA.Rua Julieta Ferrão N° 10-5°, 1600-131 Lisboa, Portugal.
Nutrients. 2025 Apr 8;17(8):1292. doi: 10.3390/nu17081292.
: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord, leading to muscle weakness, atrophy, and paralysis. Treatment focuses on symptom management, using medication, physiotherapy, and nutritional support. In this context, endoscopic gastrostomy (PEG) can provide adequate feeding, hopefully improving nutrition and preventing complications. : We studied ALS patients undergoing PEG over three months post-procedure, using anthropometry ((BMI)-body mass index; (MUAC)-mid-upper arm circumference; (TSF)-tricipital skinfold; (MAMC)-mid-arm muscle circumference) and laboratory data (Albumin; Transferrin; total cholesterol and hemoglobin), evaluating survival, complications, and nutritional/clinical status. Statistical analysis included Kaplan-Meier survival estimation and Cox regression to assess nutritional markers associated with survival. : 150 ALS patients underwent gastrostomy, mostly older adults (mean age: 66.1 years; median: 67). Mean survival was 527 [95% CI: 432-622] days, median 318 [95% CI: 236-400]. ALS bulbar subtype, MUAC and MAMC positively impacted PEG-feeding survival time ( < 0.05, Wald test). During the first three months of PEG feeding, each unit increase (cm) in MUAC and MAMC lowered death risk by 10% and 11%, respectively, highlighting the importance of nutrition care for survival. The bulbar subtype showed higher PEG feeding survival, with a 55.3% lower death hazard than the spinal subtype. There were no major PEG complications. ALS patients present a high risk of malnutrition. Patients that improved MAMC and MUAC in the first three PEG-fed months presented longer survival. Early PEG nutrition, even when some oral feeding is still possible, may reinforce the preventative role of enteral feeding in maintaining nutrition and potentially improving survival.
肌萎缩侧索硬化症（ALS）是一种进行性神经退行性疾病，会影响大脑和脊髓中的运动神经元，导致肌肉无力、萎缩和瘫痪。治疗重点在于症状管理，采用药物治疗、物理治疗和营养支持。在此背景下，内镜下胃造口术（PEG）可提供充足的喂养，有望改善营养状况并预防并发症。
我们研究了在接受PEG术后三个月内的ALS患者，使用人体测量指标（（BMI）——体重指数；（MUAC）——上臂中部周长；（TSF）——三头肌皮褶厚度；（MAMC）——上臂中部肌肉周长）和实验室数据（白蛋白；转铁蛋白；总胆固醇和血红蛋白），评估生存率、并发症以及营养/临床状况。统计分析包括Kaplan-Meier生存估计和Cox回归，以评估与生存相关的营养标志物。
150例ALS患者接受了胃造口术，大多数为老年人（平均年龄：66.1岁；中位数：67岁）。平均生存期为527[95%置信区间：432 - 622]天，中位数为318[95%置信区间：236 - 400]天。ALS延髓亚型、MUAC和MAMC对PEG喂养生存时间有积极影响（P<0.05，Wald检验）。在PEG喂养的前三个月，MUAC和MAMC每增加一个单位（厘米），死亡风险分别降低10%和11%，凸显了营养护理对生存的重要性。延髓亚型的PEG喂养生存率更高，死亡风险比脊髓亚型低55.3%。没有发生重大的PEG并发症。
ALS患者存在营养不良的高风险。在PEG喂养的前三个月中MAMC和MUAC得到改善的患者生存期更长。早期PEG营养，即使在仍有部分经口喂养可能的情况下，也可能加强肠内喂养在维持营养和潜在改善生存方面的预防作用。
