The cross-sectional area of the median nerve: An independent prognostic biomarker in amyotrophic lateral sclerosis

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY Neurologia Pub Date : 2024-09-01 DOI:10.1016/j.nrl.2022.01.008

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Abstract

Introduction

Ultrasound changes in the cross-sectional area of the median nerve (CSAmn) could be of interest as biomarkers in patients with amyotrophic lateral sclerosis (ALS).

Methods

Eighty-four ALS patients (51 men [60.7%]; mean 62.0 [SD 11.46] years old) and forty-six controls (27 men [58.7%]; mean 59.9 [SD 8.08] years old) of two different cohorts were recruited between September 2013 and February 2018. The CSAmn was measured bilaterally in each cohort, by two different examiners with two different ultrasound machines (one in each cohort). Its association with clinical variables (disease duration, muscle strength, disability, progression rate and tracheostomy-free survival) was assessed.

Results

The CSAmn was smaller in patients than in controls, and the study cohort did not influence its values. A mild correlation between the strength of the wrist flexor and the CSAmn was found. In the multivariable analysis, the probability of this association being true was 90%. In the cox regression, both a faster progression rate and a larger CSAmn independently predicted poor survival (HR = 4.29, [Cr.I95%: 2.71–6.80], p < 0.001; and HR = 1.14, [Cr.I95%: 1.03–1.25], p = 0.01), after adjusting by age, body mass index, bulbar onset, and diagnostic delay.

Conclusions

The CSAmn is an easy to assess biomarker that seems reliable and reproducible. Our data also suggest that it could act as a progression and prognostic biomarker in ALS patients. Longitudinal studies with repeated measures are warranted to confirm its usefulness in the clinical practice.

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正中神经横断面积:肌萎缩性侧索硬化症的独立预后生物标志物

方法在 2013 年 9 月至 2018 年 2 月间招募了两个不同队列的八十四名 ALS 患者（51 名男性 [60.7%]；平均 62.0 [SD 11.46] 岁）和四十六名对照组患者（27 名男性 [58.7%]；平均 59.9 [SD 8.08] 岁）。在每个队列中，由两名不同的检查人员使用两台不同的超声波机（每个队列一台）测量双侧 CSAmn。结果患者的 CSAmn 小于对照组，研究队列对其值没有影响。腕屈肌力量与 CSAmn 之间存在轻微相关性。在多变量分析中，这种关联的真实概率为 90%。在Cox回归中，在根据年龄、体重指数、球部发病和诊断延迟进行调整后，较快的进展速度和较大的CSAmn均可独立预测较差的生存率（HR = 4.29，[Cr.I95%：2.71-6.80]，p < 0.001；HR = 1.14，[Cr.I95%：1.03-1.25]，p = 0.01）。我们的数据还表明，它可以作为 ALS 患者的进展和预后生物标志物。有必要进行重复测量的纵向研究，以确认其在临床实践中的实用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurologia 医学-临床神经学

CiteScore

5.90

自引率

2.60%

发文量

135

审稿时长

48 days

期刊介绍： Neurología es la revista oficial de la Sociedad Española de Neurología y publica, desde 1986 contribuciones científicas en el campo de la neurología clínica y experimental. Los contenidos de Neurología abarcan desde la neuroepidemiología, la clínica neurológica, la gestión y asistencia neurológica y la terapéutica, a la investigación básica en neurociencias aplicada a la neurología. Las áreas temáticas de la revistas incluyen la neurologia infantil, la neuropsicología, la neurorehabilitación y la neurogeriatría. Los artículos publicados en Neurología siguen un proceso de revisión por doble ciego a fin de que los trabajos sean seleccionados atendiendo a su calidad, originalidad e interés y así estén sometidos a un proceso de mejora. El formato de artículos incluye Editoriales, Originales, Revisiones y Cartas al Editor, Neurología es el vehículo de información científica de reconocida calidad en profesionales interesados en la neurología que utilizan el español, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.