血清神经丝轻链可预测吉兰-巴雷综合征患者的长期预后。
Serum neurofilament light chain predicts long-term prognosis in Guillain-Barré syndrome patients.
作者信息
Martín-Aguilar Lorena, Camps-Renom Pol, Lleixà Cinta, Pascual-Goñi Elba, Díaz-Manera Jordi, Rojas-García Ricardo, De Luna Noemi, Gallardo Eduard, Cortés-Vicente Elena, Muñoz Laia, Alcolea Daniel, Lleó Alberto, Casasnovas Carlos, Homedes Christian, Gutiérrez-Gutiérrez Gerardo, Jimeno-Montero María Concepción, Berciano José, Sedano-Tous María José, García-Sobrino Tania, Pardo-Fernández Julio, Márquez-Infante Celedonio, Rojas-Marcos Iñigo, Jericó-Pascual Ivonne, Martínez-Hernández Eugenia, Morís de la Tassa Germán, Domínguez-González Cristina, Illa Isabel, Querol Luis
机构信息
Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
出版信息
J Neurol Neurosurg Psychiatry. 2020 Nov 5. doi: 10.1136/jnnp-2020-323899.
OBJECTIVE
To study baseline serum neurofilament light chain (sNfL) levels as a prognostic biomarker in Guillain-Barré syndrome (GBS).
METHODS
We measured NfL in serum (98 samples) and cerebrospinal fluid (CSF) (24 samples) of patients with GBS prospectively included in the International GBS Outcome Study (IGOS) in Spain using single-molecule array (SiMoA) and compared them with 53 healthy controls (HCs). We performed multivariable regression to analyse the association between sNfL levels and functional outcome at 1 year.
RESULTS
Patients with GBS had higher NfL levels than HC in serum (55.49 pg/mL vs 9.83 pg/mL, p<0.0001) and CSF (1308.5 pg/mL vs 440.24 pg/mL, p=0.034). Patients with preceding diarrhoea had higher sNfL than patients with respiratory symptoms or no preceding infection (134.90 pg/mL vs 47.86 pg/mL vs 38.02 pg/mL, p=0.016). sNfL levels correlated with Guillain-Barré Syndrome Disability Score and Inflammatory Rasch-built Overall Disability Scale (I-RODS) at every timepoint. Patients with pure motor variant and Miller Fisher syndrome showed higher sNfL levels than patients with sensorimotor GBS (162.18 pg/mL vs 95.50 pg/mL vs 38.02 pg/mL, p=0.025). Patients with acute motor axonal neuropathy cute motor axonal neuropathy had higher sNfL levels than other variants (190.55 pg/mL vs 46.79 pg/mL, p=0.013). sNfL returned to normal levels at 1 year. High baseline sNfL levels were associated with inability to run (OR=1.65, 95% CI 1.14 to 2.40, p=0.009) and lower I-RODS (β -2.60, 95% CI -4.66 to -0.54, p=0.014) at 1 year. Cut-off points predicting clinically relevant outcomes at 1 year with high specificity were calculated: inability to walk independently (>319 pg/mL), inability to run (>248 pg/mL) and ability to run (<34 pg/mL).
CONCLUSION
Baseline sNfL levels are increased in patients with GBS, are associated with disease severity and axonal variants and have an independent prognostic value in patients with GBS.
目的
研究基线血清神经丝轻链（sNfL）水平作为吉兰 - 巴雷综合征（GBS）预后生物标志物的情况。
方法
我们使用单分子阵列（SiMoA）对前瞻性纳入西班牙国际GBS结局研究（IGOS）的GBS患者的血清（98份样本）和脑脊液（CSF）（24份样本）中的NfL进行了测量，并将其与53名健康对照者（HCs）进行比较。我们进行多变量回归分析以研究sNfL水平与1年时功能结局之间的关联。
结果
GBS患者血清中的NfL水平高于HC（55.49 pg/mL对9.83 pg/mL，p<0.0001），脑脊液中的NfL水平也高于HC（1308.5 pg/mL对440.24 pg/mL，p = 0.034）。先前有腹泻的患者的sNfL高于有呼吸道症状或无先前感染的患者（134.90 pg/mL对47.86 pg/mL对38.02 pg/mL，p = 0.016）。在每个时间点，sNfL水平与吉兰 - 巴雷综合征残疾评分和炎症性拉施构建的总体残疾量表（I - RODS）相关。纯运动型变异型和米勒费雪综合征患者的sNfL水平高于感觉运动型GBS患者（162.18 pg/mL对95.50 pg/mL对38.02 pg/mL，p = 0.025）。急性运动轴索性神经病患者的sNfL水平高于其他变异型（190.55 pg/mL对46.79 pg/mL，p = 0.013）。sNfL在1年时恢复到正常水平。高基线sNfL水平与1年时无法跑步相关（OR = 1.65，95%CI 1.14至2.40，p = 0.009）以及较低的I - RODS（β -2.60，95%CI -4.66至 -0.54，p = 0.014）。计算出了预测1年时具有高特异性的临床相关结局的截断点：无法独立行走（>319 pg/mL）、无法跑步（>248 pg/mL）和能够跑步（<34 pg/mL）。
结论
GBS患者的基线sNfL水平升高，与疾病严重程度和轴索变异型相关，并且在GBS患者中具有独立的预后价值。
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