肌萎缩侧索硬化患者106例生存分析  

Analysis of survival in 106 patients with amyotrophic lateral sclerosis

作　　者：刘小璇[1] 樊东升[1] 张俊[1] 

机构地区：[1]北京大学第三医院神经科,100191

出　　处：《中华神经科杂志》2009年第6期402-405,共4页Chinese Journal of Neurology

基　　金：国家“985”计划课题资助项目（985-2-004-113）;首都医学发展科研基金资助项目（2005-1007）;国家自然科学基金资助项目（30672203）

摘　　要：目的采取回顾性研究方法探讨肌萎缩侧索硬化（ALs）的预后相关因素。方法收集1994年1月至2004年12月于北京大学第三医院就诊的ALJS患者106例，记录其临床资料、肺活量和神经功能等级评分，每3个月到半年进行面访或电话随访，直至其死亡或气管切开。用Kaplan—Meier方法计算中位生存时间，用Logrank分析各单因素变量与生存时间的关系，用Cox风险比例模型分析多变量对生存时间的影响。结果106例ALS患者平均发病年龄为（52．1±10．5）岁，确诊52例，拟诊37例，可能17例。患者的中位生存时间为35个月（95％CI30～40个月）。单因素分析发现起病部位、发病到诊断的时间和诊断时的用力肺活量为生存时间的影响因素，差异有统计学意义（Logrank6．84、43．30、4．78，均P〈0．05）。进一步用Cox风险比例模型分析，发病到诊断的时间为最有力的影响因子（Wald值20．221，风险系数0．351，P〈0．05），而性别、年龄、诊断级别、诊断时的神经功能评分情况与生存时间无明显相关。结论发病到确诊的时间为生存时间最有力的影响因子，提示ALS患者诊断时的病情发展速度与生存时间高度相关，值得进一步研究。Objective To identify the factors related to amyotrophic lateral sclerosis （ALS） prognosis in a retrospective study. Methods One hundred and six patients were evaluated with ALS enrolled in our hospital from January 1994 to December 2004. The patients were monitored with a standard evaluation form, which recorded clinical features, function rating scale （FRS） and forced vital capacity （FVC） every 3 or 6 months from visit to death or having tracheostomy. Results Mean age at onset was （52. 1± 10. 5） years. According to revised E1 Escorial diagnostic criteria （EEDC）, 52 patients had definite ALS, 37 probable ALS, 17 possible ALS. The median survival time from symptom onset was 35 months （95% CI 30-40 months）. In the univariate analysis, survival was significantly related to lesion site, lag time from onset to diagnosis and predicted FVC at diagnosis （ Log rank 6. 84, 43.30, 4.78, all P 〈 0. 05 ）. In the Cox multivariate model, lag time from onset to diagnosis was significantly related to survival （ Wald 20. 221, hazard ratio 0. 351, P 〈 0. 05 ）. Age, sex, EEDC classification, FRS at diagnosis were not related to survival. Conclusion Lag time from onset to diagnosis is a strong predictor of survival, which suggests that progression rate is highly related to survival and further study is needed.

关 键 词：肌萎缩侧索硬化 生存率分析 预后 

分 类 号：R686[医药卫生—骨科学]