Neurology Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Emergency Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Emergency Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Mult Scler Relat Disord. 2024 May;85:105478. doi: 10.1016/j.msard.2024.105478. Epub 2024 Feb 27.
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS), autoimmune inflammatory diseases of the central nervous system, affect the optic nerve and brain. A lumbar puncture to obtain biomarkers is highly invasive. Serum biomarkers and optical coherence tomography angiography (OCTA) are more accessible and less expensive than magnetic resonance imaging and provide reliable, reproducible measures of neuroaxonal damage. This study investigated the association between serum neurofilament light chain (sNfL), serum glial fibrillary acidic protein (sGFAP), and OCTA metrics. Serum sNfL and sGFAP levels, OCTA values, and clinical characteristics were compared among 91 patients with NMOSD, 81 patients with MS, and 34 healthy controls (HCs) at baseline and 1-year follow-up.
sNfL and sGFAP levels were higher while the sGFAP/sNfL quotients were significantly lower in NMOSD and MS patients than those in HCs. At baseline, the average thicknesses of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGC-IPL) were significantly smaller in NMOSD and MS patients than those in HCs (pRNFL: MS 92.0 [80.2; 101] μm, NMOSD 80.0 [59.0; 95.8] μm, vs HC 99.0 [92.0; 104] μm, p < 0.001; mGC-IPL: MS 74.5 [64.2; 81.0] μm, NMOSD 68.0 [56.0; 81.0] μm, vs HC 83.5 [78.0; 88.0] μm, p < 0.001). The vessel density (VD) and perfusion density (PD) were increased in MS patients without optic neuritis compared to HCs (VD: MS 16.7 [15.6; 17.9] HC 15.3 [13.4; 16.9], p = 0.008; PD: MS 0.41 [0.38; 0.43], HC 0.37 [0.32; 0.41], p = 0.017). In NMOSD patients without optic neuritis, sNfL was significantly associated with PD at baseline (r = 0.329, q = 0.041). The baseline and follow-up values of the sNfL level and average pRNFL and mGC-IPL thicknesses in MS patients showed significant differences. NMOSD patients showed significant differences between baseline and follow-up sNfL and sGFAP levels but not OCTA metrics.
Changes in retinal microvasculature might occur earlier than those in retinal structure and may therefore serve as a promising diagnostic marker for early NMOSD. The combination of serum markers and OCTA metrics could be used to evaluate and differentiate between MS and NMOSD.
视神经脊髓炎谱系疾病（NMOSD）和多发性硬化症（MS）是影响视神经和大脑的中枢神经系统自身免疫性疾病。腰椎穿刺获取生物标志物具有高度侵袭性。血清生物标志物和光相干断层扫描血管造影（OCTA）比磁共振成像更易获得且成本更低，能提供可靠且可重复的神经轴突损伤测量。本研究探讨了血清神经丝轻链（sNfL）、血清神经胶质纤维酸性蛋白（sGFAP）和 OCTA 指标之间的关联。在基线和 1 年随访时，比较了 91 例 NMOSD 患者、81 例 MS 患者和 34 例健康对照者（HCs）的血清 sNfL 和 sGFAP 水平、OCTA 值和临床特征。
与 HCs 相比，NMOSD 和 MS 患者的 sNfL 和 sGFAP 水平较高，而 sGFAP/sNfL 比值明显较低。在基线时，与 HCs 相比，NMOSD 和 MS 患者的视盘周围视网膜神经纤维层（pRNFL）和黄斑神经节细胞-内丛状层（mGC-IPL）平均厚度较小（pRNFL：MS 92.0[80.2；101]μm，NMOSD 80.0[59.0；95.8]μm，vs HCs 99.0[92.0；104]μm，p<0.001；mGC-IPL：MS 74.5[64.2；81.0]μm，NMOSD 68.0[56.0；81.0]μm，vs HCs 83.5[78.0；88.0]μm，p<0.001）。与 HCs 相比，无视神经炎的 MS 患者的血管密度（VD）和灌注密度（PD）增加（VD：MS 16.7[15.6；17.9]HC 15.3[13.4；16.9]，p=0.008；PD：MS 0.41[0.38；0.43]，HC 0.37[0.32；0.41]，p=0.017）。在无视神经炎的 NMOSD 患者中，sNfL 与 PD 在基线时呈显著相关（r=0.329，q=0.041）。MS 患者的基线和随访 sNfL 水平以及平均 pRNFL 和 mGC-IPL 厚度均显示出显著差异。NMOSD 患者在基线和随访时的 sNfL 和 sGFAP 水平有显著差异，但 OCTA 指标没有差异。
视网膜微血管的变化可能比视网膜结构的变化更早发生，因此可能是早期 NMOSD 的有前途的诊断标志物。血清标志物和 OCTA 指标的联合使用可用于评估和区分 MS 和 NMOSD。
