Abdo W Farid, Bloem Bastiaan R, Van Geel Wieneke J, Esselink Rianne A J, Verbeek Marcel M
Department of Neurology, Radboud University, Nijmegen Medical Centre, The Netherlands.
Neurobiol Aging. 2007 May;28(5):742-7. doi: 10.1016/j.neurobiolaging.2006.03.010. Epub 2006 May 6.
In early disease stages it can be clinically difficult to differentiate idiopathic Parkinson's disease (IPD) from patients with multiple system atrophy predominated by parkinsonism (MSA-P).
In CSF of 31 patients with IPD, 19 patients with MSA-P, we analyzed tau, neurofilament light chain (NFL) and heavy chain (NFHp35) and the noradrenergic metabolite 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG).
CSF levels of NFL, NFHp35, and tau were significantly increased in MSA-P (all p<0.0001), whereas, MHPG levels were significantly decreased in MSA-P (p<0.0001). Optimal discriminative cut-off values for the differentiation between MSA-P and IPD were calculated resulting in high sensitivity (76-94%) and specificity (83-97%) levels. Multivariate logistic regression resulted in the combination of NFL and tau as independent contributors in differentiating between MSA-P and IPD.
Higher CSF levels of axonal biomarkers could reflect advanced axonal degeneration in MSA-P. Differentiating MSA-P from IPD could be accurately possible with CSF analysis of a combination of axonal and neurotransmitter biomarkers.
在疾病早期，临床上很难将特发性帕金森病（IPD）与以帕金森综合征为主的多系统萎缩（MSA-P）患者区分开来。
我们分析了31例IPD患者和19例MSA-P患者脑脊液中的tau蛋白、神经丝轻链（NFL）和重链（NFHp35）以及去甲肾上腺素能代谢产物3-甲氧基-4-羟基苯乙二醇（MHPG）。
MSA-P患者脑脊液中NFL、NFHp35和tau蛋白水平显著升高（均p<0.0001），而MSA-P患者脑脊液中MHPG水平显著降低（p<0.0001）。计算出了区分MSA-P和IPD的最佳判别临界值，灵敏度（76-94%）和特异度（83-97%）较高。多因素逻辑回归分析显示，NFL和tau蛋白是区分MSA-P和IPD的独立因素。
脑脊液中轴突生物标志物水平升高可能反映MSA-P患者存在严重的轴突变性。通过对轴突和神经递质生物标志物进行脑脊液分析，有可能准确区分MSA-P和IPD。
