Biochemistry Department, Lyon University Hospital, Lyon, France.
Lyon Neuroscience Research Center BIORAN Team - CNRS UMR 5292, INSERM U1028, Université de Lyon, Lyon, France.
Eur J Neurol. 2020 Jul;27(7):1164-1169. doi: 10.1111/ene.14247. Epub 2020 Apr 25.
Neuropsychiatric symptoms are commonly observed in neurodegenerative diseases. No biomarker is currently available to diagnose psychiatric conditions. As a consequence, the distinction between psychiatric and neurodegenerative disorders can be challenging in daily practice.
This retrospective study included a cohort of 64 primary psychiatric patients (PSY) and 162 patients suffering from various neurodegenerative disorders (NDG). Total tau (t-Tau), phosphorylated tau (p-Tau), Aβ1-42 peptide (Aβ1-42) and neurofilament light chain protein (NfL) were analysed in cerebrospinal fluid. The discrimination between PSY and NDG patients was assessed using both individual and combined analysis of cerebrospinal fluid markers.
Cerebrospinal fluid t-Tau and NfL exhibited the best diagnostic performances: they were able to discriminate between PSY and each subgroup of NDG patients. t-Tau had the highest sensitivity (93.8%) but a poor specificity (67.3%). Indeed, some NDG subgroups exhibited low t-Tau levels comparable to PSY patients. A sequential combination t-Tau + NfL improved the characterization of patients, especially in these particular subgroups, increasing specificity up to 89.6% without modification of sensitivity. Finally, this combination of markers led to a high classification rate of 90.7% for the whole cohort of patients.
The sequential combination t-Tau + NfL enables the biological detection of neurodegeneration in patients with psychiatric features. This association of markers seems to be a promising strategy for a differential diagnosis in clinical practice between primary psychiatric conditions and neurodegenerative disorders, thus improving medical care of patients.
神经精神症状在神经退行性疾病中较为常见。目前尚无生物标志物可用于诊断精神疾病。因此，在日常实践中，区分精神疾病和神经退行性疾病具有一定挑战性。
本回顾性研究纳入了 64 名原发性精神病患者（PSY）和 162 名患有各种神经退行性疾病（NDG）的患者。分析了脑脊液中的总 tau（t-Tau）、磷酸化 tau（p-Tau）、Aβ1-42 肽（Aβ1-42）和神经丝轻链蛋白（NfL）。使用脑脊液标志物的单独和联合分析评估了 PSY 和 NDG 患者之间的区分。
脑脊液 t-Tau 和 NfL 表现出最佳的诊断性能：它们能够区分 PSY 和 NDG 患者的每个亚组。t-Tau 的敏感性最高（93.8%），但特异性较低（67.3%）。事实上，一些 NDG 亚组的 t-Tau 水平较低，与 PSY 患者相当。顺序联合 t-Tau + NfL 改善了患者的特征，特别是在这些特定的亚组中，特异性提高到 89.6%，而不改变敏感性。最后，该标志物组合对患者的整体分类率达到了 90.7%。
t-Tau + NfL 的顺序联合可用于检测具有精神特征的患者的神经退行性变。这种标记物的组合似乎是在临床实践中对原发性精神疾病和神经退行性疾病进行鉴别诊断的一种有前途的策略，从而改善了患者的医疗护理。
