Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
J Neurol. 2023 Jan;270(1):320-327. doi: 10.1007/s00415-022-11358-7. Epub 2022 Sep 3.
Serum glial fibrillary acidic protein (sGFAP) has been proposed as a biomarker in various neurological diseases but has not yet been systematically investigated in patients with cerebral small vessel disease (CSVD). We explored whether sGFAP levels are increased in stroke patients with MRI-confirmed recent small subcortical infarcts (RSSI) and analyzed the subsequent course and determinants of sGFAP longitudinally.
In a prospectively-collected cohort of stroke patients with a single RSSI (n = 101, mean age: 61 years, 73% men), we analyzed brain MRI and sGFAP using a SIMOA assay at baseline and at 3- and 15-months post-stroke. Community-dwelling age- and sex-matched individuals (n = 51) served as controls.
RSSI patients had higher baseline sGFAP levels compared to controls (median: 187.4 vs. 118.3 pg/ml, p < 0.001), with no influence of the time from stroke symptom onset to baseline blood sampling (median 5 days, range 1-13). At the 3- and 15-months follow-up, sGFAP returned to control levels. While baseline sGFAP correlated with larger infarct size (r = 0.28, p = 0.01), neither baseline nor follow-up sGFAP levels were associated with chronic CSVD-related lesions (white matter hyperintensities, lacunes, microbleeds) after adjusting for age, sex and hypertension. Furthermore, sGFAP levels did not relate to the occurrence of new vascular brain lesions on follow-up MRI.
sGFAP is increased in patients with CSVD-related stroke and correlates with the size of the RSSI. However, sGFAP levels were not related to chronic neuroimaging features or progression of CSVD, suggesting that sGFAP is sensitive to acute but not chronic cerebrovascular tissue changes in this condition.
血清神经胶质纤维酸性蛋白（sGFAP）已被提议作为各种神经疾病的生物标志物，但尚未在脑小血管疾病（CSVD）患者中进行系统研究。我们探讨了 MRI 证实近期小皮质下梗死（RSSI）的中风患者中 sGFAP 水平是否升高，并分析了 sGFAP 的后续病程及其纵向决定因素。
在一项前瞻性收集的具有单个 RSSI 的中风患者队列中（n=101，平均年龄：61 岁，73%男性），我们使用 SIMOA 测定法在基线和中风后 3 个月和 15 个月时分析脑 MRI 和 sGFAP。年龄和性别匹配的社区居住个体（n=51）作为对照。
RSSI 患者的基线 sGFAP 水平高于对照组（中位数：187.4 与 118.3 pg/ml，p<0.001），且与从中风症状发作到基线采血的时间无关（中位数 5 天，范围 1-13）。在 3 个月和 15 个月的随访中，sGFAP 恢复到对照水平。尽管基线 sGFAP 与较大的梗死灶大小相关（r=0.28，p=0.01），但在校正年龄、性别和高血压后，基线和随访 sGFAP 水平均与慢性 CSVD 相关病变（白质高信号、腔隙、微出血）无关。此外，sGFAP 水平与随访 MRI 上新的血管性脑病变的发生无关。
CSVD 相关中风患者的 sGFAP 增加，并与 RSSI 的大小相关。然而，sGFAP 水平与慢性神经影像学特征或 CSVD 的进展无关，这表明 sGFAP 对这种情况下的急性但非慢性脑血管组织变化敏感。
