Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Brain Behav. 2022 Sep;12(9):e2700. doi: 10.1002/brb3.2700. Epub 2022 Aug 4.
Improved prognostication remains vital in multiple sclerosis to inform personalized treatment approaches. Blood neurofilament light (bNfL) is a promising prognostic biomarker, but to what extent it provides additional information, independent of established MRI metrics, is yet to be established.
We obtained all available bNfL data for 133 patients from a longitudinal observational cohort study. Patients were dichotomized into good or poor outcome groups based upon clinical and cognitive assessments performed 15 years after a clinically isolated syndrome. We performed longitudinal modeling of early NfL and MRI variables to examine differences between outcome groups.
The bNfL dataset was incomplete, with one to three (mean 1.5) samples available per participant. Within 3 months of onset, bNfL was similar between groups. The bNfL concentration subsequently decreased in those with a good outcome, and remained persistently elevated in those with a poor outcome. By year 5, NfL in the poor outcome group was approximately double that of those with a good outcome (14.58 [10.40-18.77] vs. 7.71 [6.39-9.04] pg/ml, respectively). Differences were reduced after adjustment for longitudinal changes in T2LV, but trends persisted for a greater rate of increase in NfL in those with a poor outcome, independent of T2LV.
This analysis requires replication in cohorts with more complete bNfL datasets, but suggests that persistently elevated blood NfL may be more common in patients with a poor long-term outcome. Persistent elevation of blood NfL may provide additional prognostic information not wholly accounted for by standard monitoring techniques.
在多发性硬化症中，改善预后仍然至关重要，以便为个性化治疗方法提供信息。血液神经丝轻链（bNfL）是一种很有前途的预后生物标志物，但它在多大程度上提供了独立于既定 MRI 指标的额外信息，还有待确定。
我们从一项纵向观察队列研究中获得了 133 名患者的所有可用 bNfL 数据。根据临床孤立综合征后 15 年进行的临床和认知评估，将患者分为预后良好或不良组。我们对早期 NfL 和 MRI 变量进行了纵向建模，以检查两组之间的差异。
bNfL 数据集不完整，每个参与者只有一到三个（平均 1.5）样本可用。在发病后 3 个月内，两组间 bNfL 相似。随后，预后良好者的 bNfL 浓度下降，而预后不良者的 bNfL 浓度持续升高。到第 5 年时，预后不良者的 NfL 约为预后良好者的两倍（分别为 14.58 [10.40-18.77] pg/ml 和 7.71 [6.39-9.04] pg/ml）。在调整 T2LV 的纵向变化后，差异有所缩小，但在不考虑 T2LV 的情况下，预后不良者 NfL 增加速度更快的趋势仍然存在。
该分析需要在具有更完整 bNfL 数据集的队列中进行复制，但表明持续升高的血液 NfL 可能在预后不良的患者中更为常见。血液 NfL 的持续升高可能提供了标准监测技术无法完全解释的额外预后信息。
