Shen Xue-Ning, Huang Shu-Yi, Cui Mei, Zhao Qian-Hua, Guo Yu, Huang Yu-Yuan, Zhang Wei, Ma Ya-Hui, Chen Shi-Dong, Zhang Ya-Ru, Chen Shu-Fen, Chen Ke-Liang, Cheng Wei, Zuo Chuan-Tao, Tan Lan, Ding Ding, Dong Qiang, Jeromin Andreas, Yen Tzu-Chen, Yu Jin-Tai
Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
National Center for Neurological Disorders, Shanghai, China.
Clin Chem. 2023 Apr 3;69(4):411-421. doi: 10.1093/clinchem/hvad018.
Plasma glial fibrillary acidic protein (GFAP) has emerged as a promising biomarker in neurological disorders, but further evidence is required in relation to its usefulness for diagnosis and prediction of Alzheimer disease (AD).
Plasma GFAP was measured in participants with AD, non-AD neurodegenerative disorders, and controls. Its diagnostic and predictive value were analyzed alone or combined with other indicators.
A total of 818 participants were recruited (210 followed). Plasma GFAP was significantly higher in AD than in non-AD dementia and non-demented individuals. It increased in a stepwise pattern from preclinical AD, through prodromal AD to AD dementia. It effectively distinguished AD from controls [area under the curve (AUC) > 0.97] and non-AD dementia (AUC > 0.80) and distinguished preclinical (AUC > 0.89) and prodromal AD (AUC > 0.85) from Aβ-normal controls. Adjusted or combined with other indicators, higher levels of plasma GFAP displayed predictive value for risk of AD progression (adjusted hazard radio= 4.49, 95%CI, 1.18-16.97, P = 0.027 based on the comparison of those above vs below average at baseline) and cognitive decline (standard-β=0.34, P = 0.002). Additionally, it strongly correlated with AD-related cerebrospinal fluid (CSF)/neuroimaging markers.
Plasma GFAP effectively distinguished AD dementia from multiple neurodegenerative diseases, gradually increased across the AD continuum, predicted the individual risk of AD progression, and strongly correlated with AD CSF/neuroimaging biomarkers. Plasma GFAP could serve as both a diagnostic and predictive biomarker for AD.
血浆胶质纤维酸性蛋白（GFAP）已成为神经疾病中一种有前景的生物标志物，但关于其在阿尔茨海默病（AD）诊断和预测方面的实用性还需要更多证据。
对患有AD、非AD神经退行性疾病的参与者以及对照组进行血浆GFAP检测。单独或与其他指标联合分析其诊断和预测价值。
共招募了818名参与者（随访210名）。AD患者的血浆GFAP显著高于非AD痴呆患者和非痴呆个体。从临床前AD、前驱期AD到AD痴呆，其呈逐步升高趋势。它能有效区分AD与对照组[曲线下面积（AUC）>0.97]以及非AD痴呆（AUC>0.80），并区分临床前（AUC>0.89）和前驱期AD（AUC>0.85）与Aβ正常对照组。调整或与其他指标联合后，较高水平的血浆GFAP对AD进展风险具有预测价值（调整后的风险比=4.49，95%CI，1.18 - 16.97, P = 0.027，基于基线时高于或低于平均水平者的比较）以及认知衰退（标准β=0.34, P = 0.002）。此外，它与AD相关的脑脊液（CSF）/神经影像学标志物密切相关。
血浆GFAP能有效区分AD痴呆与多种神经退行性疾病，在AD连续体中逐渐升高，预测个体AD进展风险，并与AD脑脊液/神经影像学生物标志物密切相关。血浆GFAP可作为AD的诊断和预测生物标志物。
