Department of Neurology, Medical University of Vienna, Vienna, Austria.
Division of Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria.
J Neuroinflammation. 2020 Mar 17;17(1):86. doi: 10.1186/s12974-020-01737-0.
Guillain-Barré syndrome (GBS) is an autoimmune disease that results in demyelination and axonal damage. Five percent of patients die and 20% remain significantly disabled on recovery. Recovery is slow in most cases and eventual disability is difficult to predict, especially early in the disease. Blood or cerebrospinal fluid (CSF) biomarkers that could help identify patients at risk of poor outcome are required. We measured serum neurofilament light chain (sNfL) concentrations from blood taken upon admission and investigated a correlation between sNfL and clinical outcome.
Baseline sNfL levels in 27 GBS patients were compared with a control group of 22 patients with diagnoses not suggestive of any axonal damage. Clinical outcome parameters for GBS patients included (i) the Hughes Functional Score (HFS) at admission, nadir, and discharge; (ii) the number of days hospitalised; and (iii) whether intensive care was necessary.
The median sNfL concentration in our GBS sample on admission was 85.5 pg/ml versus 9.1 pg/ml in controls. A twofold increase in sNfL concentration at baseline was associated with an HFS increase of 0.6 at nadir and reduced the likelihood of discharge with favourable outcome by a factor of almost three. Higher sNfL levels upon admission correlated well with hospitalisation time (r = 0.69, p < 0.0001), during which transfer to intensive care occurred more frequently at an odds ratio of 2.4. Patients with baseline sNfL levels below 85.5 pg/ml had a 93% chance of being discharged with an unimpaired walking ability.
sNfL levels measured at hospital admission correlated with clinical outcome in GBS patients. These results represent amounts of acute axonal damage and reflect mechanisms resulting in disability in GBS. Thus, sNfL may serve as a convenient blood-borne biomarker to personalise patient care by identifying those at higher risk of poor outcome.
吉兰-巴雷综合征（GBS）是一种自身免疫性疾病，可导致脱髓鞘和轴索损伤。5%的患者死亡，20%的患者在康复后仍存在显著残疾。大多数情况下康复缓慢，尤其是在疾病早期，最终残疾程度难以预测。需要血液或脑脊液（CSF）生物标志物来帮助识别预后不良的患者。我们测量了入院时采集的血清神经丝轻链（sNfL）浓度，并研究了 sNfL 与临床结局之间的相关性。
将 27 例 GBS 患者的基线 sNfL 水平与 22 例无轴索损伤诊断的对照组进行比较。GBS 患者的临床结局参数包括：（i）入院时、最低时和出院时的休斯功能评分（HFS）；（ii）住院天数；以及（iii）是否需要重症监护。
我们的 GBS 样本入院时的中位 sNfL 浓度为 85.5pg/ml，而对照组为 9.1pg/ml。基线时 sNfL 浓度增加两倍与最低时 HFS 增加 0.6 相关，使出院时预后良好的可能性降低近三倍。入院时较高的 sNfL 水平与住院时间相关性良好（r=0.69，p<0.0001），在此期间，因更频繁发生需要转入重症监护而住院时间延长的几率为 2.4。基线 sNfL 水平低于 85.5pg/ml 的患者有 93%的可能性出院时行走能力不受影响。
入院时测量的 sNfL 水平与 GBS 患者的临床结局相关。这些结果代表了急性轴索损伤的程度，并反映了导致 GBS 患者残疾的机制。因此，sNfL 可能作为一种方便的血液生物标志物，通过识别预后不良风险较高的患者来实现患者护理的个体化。
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