Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Box 440, 405 30, Gothenburg, Sweden.
Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Neurol. 2019 Nov;266(11):2796-2806. doi: 10.1007/s00415-019-09477-9. Epub 2019 Aug 2.
Neurofilament light chain (NfL) is a marker of neuroaxonal damage. We aimed to study associations between serum NfL (sNfL) concentrations at different time points after ischemic stroke and outcomes.
We prospectively included ischemic stroke cases (n = 595, mean age 59 years, 64% males) and assessed outcomes by both the modified Rankin Scale (mRS) and the NIH stroke scale (NIHSS) at 3 months and by mRS at 2 years. In a subsample, long-term (7-year) outcomes were also assessed by both mRS and NIHSS. We used the ultrasensitive single-molecule array assay to measure sNfL in the acute phase (range 1-14, median 4 days), after 3 months and 7 years in cases and once in controls (n = 595).
Acute-phase sNfL increased by the time to blood-draw and highest concentrations were observed at 3 months post-stroke. High sNfL associated to stroke severity and poor outcomes, and both associations were strongest for 3-month sNfL. After adjusting for age, previous stroke, stroke severity, and day of blood draw, 3-month sNfL was significantly associated to both outcomes at all time points (p < 0.01 throughout). For all main etiological subtypes, both acute phase and 3-month sNfL were significantly higher than in controls, but the dynamics of sNfL differed by stroke subtype.
The results from this study inform on sNfL in ischemic stroke and subtypes over time, and show that sNfL predicts short- and long-term neurological and functional outcomes. Our findings suggest a potential utility of sNfL in ischemic stroke outcome prediction.
神经丝轻链（NfL）是神经轴突损伤的标志物。我们旨在研究缺血性卒中后不同时间点血清 NfL（sNfL）浓度与结局之间的关系。
我们前瞻性纳入了 595 例缺血性卒中病例（平均年龄 59 岁，64%为男性），并在 3 个月时通过改良 Rankin 量表（mRS）和 NIH 卒中量表（NIHSS）以及在 2 年时通过 mRS 评估结局。在一个亚组中，我们还通过 mRS 和 NIHSS 评估了长期（7 年）结局。我们使用超敏单分子阵列测定法在急性期（范围 1-14，中位数 4 天）、卒中后 3 个月和 7 年时测量病例组和对照组（n=595）的 sNfL。
急性期 sNfL 随采血时间而增加，在卒中后 3 个月时观察到最高浓度。高 sNfL 与卒中严重程度和不良结局相关，而这两种关联在 3 个月 sNfL 时最强。在校正年龄、既往卒中、卒中严重程度和采血日之后，3 个月 sNfL 与所有时间点的所有结局均显著相关（p<0.01 始终）。对于所有主要病因亚型，急性期和 3 个月 sNfL 均显著高于对照组，但 sNfL 的动态变化因卒中亚型而异。
本研究的结果提供了缺血性卒中及各亚型随时间推移的 sNfL 信息，并表明 sNfL 可预测短期和长期神经功能和功能结局。我们的研究结果提示 sNfL 可能对缺血性卒中结局预测具有潜在的应用价值。
