背景:LAMA2相关营养不良(LAMA2-RD)是一组罕见的神经肌肉疾病,具有广泛的表型严重程度,范围从轻度到重度。我们通过运动功能和肺部检查对LAMA2-RD进行了横断面研究,以确定疾病的自然史。
方法:纳入了44名LAMA2-RD患者,并通过包括运动功能测量32(MFM32)在内的功能结果测量进行了一次评估,修改上肢模块(RULM)测角,和强制肺活量(FVC)。固定效应回归模型(ERM)和Kaplan-Meier曲线用于计算疾病进展率结果:患者年龄在2至25岁之间(平均11.4),最常见的表型表现为非门诊(N=36,81.8%),8例(18,2%)为门诊.非卧床组表现出更严重的疾病进展。非门诊患者的FVC/年下降1.85%,而门诊患者的FVC/年下降1.32%。在非救护车组中,MFM32-D2领域每年下降4.2%(p<0.00001),D3领域每年下降2.6%(p<0.0001),MFM32全球评估每年下降2.7%(p<0.0001)。然而,非卧床组通过RULM量表对上肢功能的评估未显示统计学上的显著降低.在非救护车组中,肘部和膝部收缩恶化3.22度/年(p=0.00087)和1.92度/年,分别。而在那些获得步态的患者中,肘部和膝部收缩恶化2.45度/年(p=0.0003)和1.73度/年(p=0.01),分别。
结论:这项研究证实了LAMA2-RD的进行性,无论是在流动和非流动的病人。MFM32,FVC,和测角法被确定为LAMA2-RD的自然史研究和临床试验的有希望的结果指标。
BACKGROUND: LAMA2-related dystrophies (LAMA2-RD) are a rare group of neuromuscular disorders with a broad spectrum of phenotype severity, ranging from mild to severe. We performed a cross-sectional study of LAMA2-RD through motor function and pulmonary tests to establish the disease\'s natural history.
METHODS: Forty-four individuals with LAMA2-RD were included and evaluated once through functional outcome measures including Motor Function Measure 32 (MFM32), Revised Upper Limb Module (RULM),
goniometry, and Forced Vital Capacity (FVC). Fixed Effect Regression Model (ERM) and Kaplan-Meier curve were used for calculating the rate of the disease progression RESULTS: Patients were between 2 and 25 years old (mean 11.4), the most frequent phenotype presentation was non-ambulant (N=36, 81.8%) while eight patients (18,2 %) were ambulant. The non-ambulant group presented a more severe progression of the disease. Non-ambulant patients had a 1.85 % decrease in FVC/year against 1.32 %/year among ambulant patients. In the non-ambulant group, there was a 4.2 % drop/year in the MFM32-D2 domain (p<0.00001), a 2.6 % drop/year in the D3 domain (p<0.0001), and a 2.7 % drop/year in the MFM32 global assessment (p<0.0001). However, the non-ambulant group\'s evaluation of upper limb function through the RULM scale did not show a statistically significant reduction. In the non-ambulant group, elbow and knee retractions worsened 3.22 degrees/year (p=0.00087) and 1.92 degrees/year, respectively. While in those patients who acquired gait, elbow and knee retractions worsened 2.45 degrees/year (p=0.0003) and 1.73 degrees/year (p=0.01), respectively.
CONCLUSIONS: This study confirmed the progressive nature of LAMA2-RD, both in ambulant and non-ambulant patients. MFM32, FVC, and
goniometry were identified as promising outcome measures for natural history studies and clinical trials in LAMA2-RD.