中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (3): 591-595.doi: 10.4103/1673-5374.293159

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

肌萎缩性侧索硬化诊断和预后预测中肌酸激酶的作用

  

  • 出版日期:2021-03-15 发布日期:2020-12-17
  • 基金资助:
    中国国际自然科学基金项目(81301093)

Creatine kinase in the diagnosis and prognostic prediction of amyotrophic lateral sclerosis: a retrospective case-control study

Xue-Ping Chen, Qian-Qian Wei, Ru-Wei Ou, Yan-Bing Hou, Ling-Yu Zhang, Xiao-Qin Yuan, Yun-Qian Yao, De-Sheng Jia, Qian Zhang, Wei-Xue Li, Hui-Fang Shang*   

  1. Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
  • Online:2021-03-15 Published:2020-12-17
  • Contact: Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
  • Supported by:
    This study was supported by the National Natural Science Foundation of China, No. 81301093 (to XPC).

摘要:

肌酸激酶是一种肌肉酶,但在不同的研究中肌萎缩性侧索硬化患者的肌酸激酶变化情况不一。作者以回顾性病例对照方法纳入2008年5月至2018年12月在华西医院神经内科收治的年龄/性别匹配的582例肌萎缩性侧索硬化患者和582例健康对照者。分析结果发现肌萎缩性侧索硬化患者血清肌酸激酶水平远高于正常对照者。进一步亚组分析发现,在肌萎缩性侧索硬化患者和健康对照者中,男性血清肌酸激酶水平均高于女性。与延髓发作患者相比,肢体发作肌萎缩性侧索硬化患者血清肌酸激酶水平更高。Spearman相关性分析发现血清肌酸激酶水平与体质量指数、ALSFRS-R评分或进展速度无关。但是在调整了预后的协变量后,发现较高的肌酸激酶对数与更好的肌萎缩性侧索硬化生存率有关。但包含81例肌萎缩性侧索硬化的纵向研究显示,在疾病进展期血清肌酸激酶水平可能在6个月后下降。结果说明血清肌酸激酶水平似乎可以作为是肌萎缩性侧索硬化生存预后的独立因素。试验于2015年12月23日经四川大学华西医院伦理委员会批准,批准号2015(236)。

https://orcid.org/0000-0003-0947-1151 (Hui-Fang Shang)

关键词: 肌萎缩性侧索硬化, 血清学, 生物标志物, 肌酸激酶, 诊断, 预后, 生存, 流行病学研究

Abstract: Creatine kinase is a muscle enzyme that has been reported at various levels in different studies involving patients with amyotrophic lateral sclerosis. In the present retrospective case-control study, we included 582 patients with amyotrophic lateral sclerosis and 582 age- and sex-matched healthy controls. All amyotrophic lateral sclerosis participants received treatment in the Department of Neurology, West China Hospital, China, between May 2008 and December 2018. Serum creatine kinase levels in patients with amyotrophic lateral sclerosis were significantly higher than those in healthy controls. Subgroup analysis revealed that serum creatine kinase levels in men were higher than those in women in both amyotrophic lateral sclerosis patients and healthy controls. Compared with patients with bulbar-onset amyotrophic lateral sclerosis, patients with limb-onset amyotrophic lateral sclerosis had higher creatine kinase levels. Spearman’s correlation analysis revealed that serum creatine kinase levels were not correlated with body mass index, amyotrophic lateral sclerosis Functional Rating Scale-Revised score, or progression rate. After adjusting for prognostic covariates, higher log creatine kinase values were correlated with higher overall survival in the amyotrophic lateral sclerosis patients. We also investigated the longitudinal changes in serum creatine kinase levels in 81 amyotrophic lateral sclerosis patients; serum creatine kinase levels were decreased at the second blood test, which was sampled at least 6 months after the first blood test. Together, our results suggest that serum creatine kinase levels can be used as an independent factor for predicting the prognosis of amyotrophic lateral sclerosis patients. This study received ethical approval from the Ethics Committee of West China Hospital, China (approval no. 2015(236)) on December 23, 2015.

Key words: amyotrophic lateral sclerosis, biomarker, creatine kinase, diagnosis, epidemiological study, prognosis, serology, survival