Abstract

Background: Trauma especially head trauma is considered a potential risk factor of amyotrophic lateral sclerosis (ALS), but their association has not been well established. We aimed to determine the association of prior trauma with ALS risk. Methods: This study was performed according to the Meta-Analysis of Observational Studies in Epidemiology guideline to assess related literatures, and a random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Twenty-nine eligible articles involving 18,390 cases and 6,519,391 controls were included in this meta-analysis. The results showed that trauma was associated with an increased risk of ALS (pooled OR = 1.51, 95% CI: 1.32–1.73). Besides, patients with trunk trauma, head trauma and lower limb trauma had an increased risk of ALS, whereas no evidence suggested that upper limb trauma and spine trauma could increase ALS risk. Considering the number of traumatic events, the association between trauma and ALS risk was significant for patients with repeated trauma events (pooled OR = 1.21, 95% CI: 1.07–1.38). The results showed that individuals with a history of trauma within 5 years were more likely to be diagnosed with ALS (pooled OR = 1.84, 95% CI: 1.56–2.17). Importantly, both old trauma and very old trauma were found to be associated with an increased risk of ALS (pooled OR = 1.24, 95% CI: 1.12–1.38; pooled OR = 1.28, 95% CI: 1.10–1.49; respectively). Conclusions: This meta-analysis indicated that trauma could increase ALS risk, which may be applied for the clinicians to tailor targeted treatment regimens and make prophylactic strategies for ALS in traumatic patients.

摘要

背景：创伤（尤其是头部创伤）被认为是肌萎缩性侧索硬化症（ALS）的潜在危险因素，但它们之间的关联尚未得到很好的确立。我们旨在确定先前创伤与ALS风险的关联。方法：本研究是根据《流行病学观察性研究指南》的荟萃分析进行的，以评估相关文献，并使用随机效应模型计算比值比（OR）和95％置信区间（CI）。结果：该荟萃分析纳入了29篇合格文章，涉及18,390例病例和6,519,391例对照。结果表明，创伤与ALS风险增加相关（合并OR = 1.51，95％CI：1.32-1.73）。此外，躯干外伤，头部外伤和下肢外伤的患者发生ALS的风险增加，而没有证据表明上肢外伤和脊柱外伤可能增加ALS的风险。考虑到创伤事件的数量，对于重复创伤事件的患者，创伤与ALS风险之间的相关性显着（合并OR = 1.21，95％CI：1.07-1.38）。结果表明，有5年内有创伤史的人更容易被诊断为ALS（合并OR = 1.84，95％CI：1.56-2.17）。重要的，结论：这项荟萃分析表明，创伤可能会增加ALS的风险，可用于临床医生制定针对性治疗方案并制定创伤性患者ALS的预防策略。