ALS 是一种进展性疾病,没有缓解、复发或稳定期,导致进行性残疾并最终死亡。 受累个体的临床表现和病程有很大的差异。 中位生存期为 3-5 年,单亦有患者生存 10 年或更久(尽管十分罕见,约 10%-20% )的报道。[103]Turner MR, Parton MJ, Shaw CE, et al. Prolonged survival in motor neuron disease: a descriptive study of the King's database 1990-2002. J Neurol Neurosurg Psychiatry. 2003;74:995-997.http://www.ncbi.nlm.nih.gov/pubmed/12810805?tool=bestpractice.com[104]Chiò A, Logroscino G, Hardiman O, et al; Eurals Consortium. Prognostic factors in ALS: a critical review. Amyotroph Lateral Scler. 2009;10:310-323.http://www.ncbi.nlm.nih.gov/pubmed/19922118?tool=bestpractice.com
预后因素
对存活期有积极影响的预后因素包括:
使用无创正压通气 (NIPPV) 治疗[104]Chiò A, Logroscino G, Hardiman O, et al; Eurals Consortium. Prognostic factors in ALS: a critical review. Amyotroph Lateral Scler. 2009;10:310-323.http://www.ncbi.nlm.nih.gov/pubmed/19922118?tool=bestpractice.com
肠内营养[76]Katzberg, HD, Benatar M. Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev. 2011;(1):CD004030.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004030.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/21249659?tool=bestpractice.com
诊断时年龄较轻
肢体起病[105]Jablecki CK, Berry C, Leach J. Survival prediction in amyotrophic lateral sclerosis. Muscle Nerve. 1989;12:833-841.http://www.ncbi.nlm.nih.gov/pubmed/2608080?tool=bestpractice.com[106]Eisen A, Schulzer M, MacNeil M, et al. Duration of amyotrophic lateral sclerosis is age dependent. Muscle Nerve. 1993;16:27-32.http://www.ncbi.nlm.nih.gov/pubmed/8423829?tool=bestpractice.com[107]Czaplinski A, Yen AA, Appel SH. Forced vital capacity (FVC) as an indicator of survival and disease progression in an ALS clinic population. J Neurol Neurosurg Psychiatry. 2006;77:390-392.http://www.ncbi.nlm.nih.gov/pubmed/16484652?tool=bestpractice.com
基线 FVC >75%(中位生存期 5 年)。[107]Czaplinski A, Yen AA, Appel SH. Forced vital capacity (FVC) as an indicator of survival and disease progression in an ALS clinic population. J Neurol Neurosurg Psychiatry. 2006;77:390-392.http://www.ncbi.nlm.nih.gov/pubmed/16484652?tool=bestpractice.com
与预后不良相关的预后因素包括:
诊断时年龄较大
延髓起病
合并额颞叶痴呆
基线 FVC <75%。
症状进展速度被视为一个独立的预后因素。[104]Chiò A, Logroscino G, Hardiman O, et al; Eurals Consortium. Prognostic factors in ALS: a critical review. Amyotroph Lateral Scler. 2009;10:310-323.http://www.ncbi.nlm.nih.gov/pubmed/19922118?tool=bestpractice.com