From the Department of Neurology (Z.Z., X.H., Q.D.), Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University; and Department of Radiology (W.T., L.G.), Huashan Hospital, Fudan University, Shanghai, China.
Neurology. 2018 Feb 27;90(9):e732-e737. doi: 10.1212/WNL.0000000000005027. Epub 2018 Jan 31.
To explore the value of plasma fibrillin-1 levels in patients with spontaneous cerebral artery dissection (sCeAD).
A single-center prospective cohort of 99 consecutive patients with sCeAD between February 2013 and December 2015 were age and sex matched with 115 patients with non-sCeAD ischemic stroke and 20 healthy participants undergoing routine physical examination. The plasma fibrillin-1 level was measured with ELISA and compared among the 3 groups. The associations of fibrillin-1 with site, acuity, and severity of dissection, as well as clinical and radiographic prognosis of patients, were analyzed.
One hundred nine plasma samples from 99 patients with sCeAD, 115 from disease control patients, and 20 from healthy participants were collected. The plasma fibrillin-1 level of the dissection group (mean 85.56 ng/mL [95% confidence interval 81.53-89.59]) was higher than that of non-sCeAD ischemic stroke group (77.13 ng/mL [73.64-80.63], = 0.015) or healthy controls (73.04 ng/mL [65.94-80.13], = 0.029). Such differences were most prominent in the acute stage (97.64 ng/mL [91.64-103.64], 74.39 ng/mL [68.95-79.84], and 73.04 ng/mL [65.95-80.13], respectively). A cutoff value of 88.455 ng/mL was determined to differentiate acute dissection from nondissection stroke with a sensitivity of 0.778 and a specificity of 0.800. Higher fibrillin-1 level was detected in patients with more severe dissection radiographically ( < 0.001), while patients with lower fibrillin-1 concentration at baseline achieved better morphologic recovery on follow-up imaging tests ( = 0.003).
Plasma fibrillin-1 is a promising biomarker for aiding the diagnosis of acute sCeAD and may have potential value in lesion severity grading and radiographic prognosis prediction.
This study provides Class III evidence that patients with sCeAD have significantly higher levels of plasma fibrillin-1 than patients with ischemic stroke attributable to a cause other than sCeAD.
探讨血浆原纤维蛋白-1水平在自发性脑动脉夹层（sCeAD）患者中的价值。
本研究为单中心前瞻性队列研究，纳入 2013 年 2 月至 2015 年 12 月期间连续 99 例 sCeAD 患者，并与 115 例非 sCeAD 缺血性脑卒中患者和 20 例健康体检者进行年龄和性别匹配。采用 ELISA 法检测血浆原纤维蛋白-1 水平，并比较三组之间的差异。分析原纤维蛋白-1与夹层部位、严重程度和发病急缓的相关性，及其对患者临床和影像学预后的影响。
共纳入 99 例 sCeAD 患者的 109 份血浆样本、115 份非 sCeAD 缺血性脑卒中患者的血浆样本和 20 份健康对照者的血浆样本。夹层组患者的血浆原纤维蛋白-1水平[平均 85.56ng/mL（95%置信区间 81.5389.59）]高于非 sCeAD 缺血性脑卒中组[77.13ng/mL（73.6480.63），=0.015]或健康对照组[73.04ng/mL（65.9480.13），=0.029]。急性发病期的差异最为显著[夹层组为 97.64ng/mL（91.64103.64），非 sCeAD 缺血性脑卒中组为 74.39ng/mL（68.9579.84），健康对照组为 73.04ng/mL（65.9580.13）]。将 88.455ng/mL 作为区分急性夹层与非夹层脑卒中的截断值，其诊断急性 sCeAD 的灵敏度为 0.778，特异度为 0.800。影像学上表现为更严重夹层的患者，其原纤维蛋白-1 水平更高（<0.001），而基线时原纤维蛋白-1 浓度较低的患者在随访影像学检查中获得更好的形态学恢复（=0.003）。
血浆原纤维蛋白-1 是辅助诊断急性 sCeAD 的有前途的生物标志物，可能对病变严重程度分级和影像学预后预测有潜在价值。
本研究提供了 III 级证据，表明 sCeAD 患者的血浆原纤维蛋白-1 水平明显高于非 sCeAD 缺血性脑卒中患者。
