1.1 Enrollment criteria: ALS patients were selected from the first confirmed patients admitted to the neurology clinic from January 2016 to August 2020. The enrolled 90 patients (50 males and 40 females) were all met the EI Escorial amyotrophic lateral sclerosis clinical diagnostic criteria revised in 2000 by the Motor Neuron Disease Group of the World Federation of Neurology [1]. The average age of the patients is (58.9 ±9.9) years old. EMG examination is performed on all patients. The enrollment criteria are as follows: (1) There are three conditions that the patients must be met: firstly, the evidence of lower motor neuron injury must be found through clinical, electrophysiological or neuropathological examination. secondly, evidence of upper motor neuron lesion must be confirmed by clinical examination. Finally, the upper and lower motor neuron lesions spread from one part to other parts gradually based on medical history or examination. (2) There are two conditions that must be excluded at the same time: at first, Patient suffering from other diseases that cause upper and lower motor neuron lesions are proven through electrophysiology or pathology. secondly, Neuroimaging proves that the patient has other diseases lead to clinical manifestations of upper and lower motor neuron diseases and electrical physiological changes.
1.2 Exclusion criteria: (1) The patients suffering from acute cardiovascular and cerebrovascular events, stroke, acute coronary syndrome. (2) Those who also suffer from other neurodegenerative diseases, such as multiple system atrophy, Parkinson's disease, frontotemporal dementia, etc. (3) Those who also suffer from renal insufficiency or gout. The renal function is evaluated by the glomerular filtration rate. When the glomerular filtration rate is less than 90ml/min, it means renal insufficiency. (4) Those with mental symptoms and cognitive impairment who cannot cooperate with the test; Patients with severe liver and kidney disease or malignant tumors or thyroid disease or patients who have taken drugs that affect monitoring indicators in the past 3 months (such as lipid-lowering drugs, diuretics, folic acid, B vitamins, etc.). (5) The patients who have a confirmed ALS in their family or similar symptoms but undiagnosed patients.
1.3 Healthy control group: 80 healthy volunteers had a physical examination in the physical examination center of our hospital during the same period. Patients with mental disorders, severe liver and kidney diseases, thyroid diseases, and malignant tumors were excluded, and those who had taken drugs that affected the observed indicators in the past 3 months were also excluded (such as lipid-lowering drugs, diuretics, folic acid, B vitamins, etc.). There were 42 males and 38 females, aged 35-77 (59.34±7.71) years old. There was no age and gender bias between the control group and the ALS patient group.