神经丝轻链作为吉兰-巴雷综合征的诊断和预后生物标志物。

Neurofilament light chain as a diagnostic and prognostic biomarker in Guillain-Barré syndrome.

机构信息

Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Department of Neurology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.

出版信息

J Neurol. 2024 Nov;271(11):7282-7293. doi: 10.1007/s00415-024-12679-5. Epub 2024 Sep 9.

DOI:10.1007/s00415-024-12679-5

PMID:39249104

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11561089/

Abstract

BACKGROUND

Elevated neurofilament light chain (NfL) levels are associated with worse prognosis in Guillain-Barré syndrome (GBS). Our objectives were to determine the utility of serum NfL (sNfL), cerebrospinal fluid (CSF)/serum NfL ratio and NfL index as prognostic and diagnostic biomarkers for GBS.

METHODS

We measured NfL in serum and/or CSF obtained from 96 GBS patients between 1989 and 2014 in western Sweden. The sNfL Z-scores, NfL ratios and NfL indices were calculated. Outcome was determined with the GBS disability scale (GBSDS) at 3 and 12 months. NfL parameters in GBS were compared with healthy controls (HC), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS).

RESULTS

The sNfL Z-score was higher for GBSDS > 2 at 3 months (median [IQR], 3.5 ng/L [3.2-4.0], vs 2.6 [1.7-3.4], p = 0.008) and at 12 months (3.6 ng/L [3.5-3.8] vs 2.6 [1.8-3.5], p = 0.049). NfL ratio and index were not associated with outcome. The area under the curve (AUC) for sNfL Z-score was 0.76 (95% CI 0.58-0.93, p < 0.0001) for GBSDS > 2 at 3 months. NfL ratio and index were lower in GBS than HC, MS, and ALS. The AUC for the NfL ratio was 0.66 (95% CI 0.55-0.78, p = 0.0018) and for the NfL index 0.86 (95% CI 0.78-0.93, p < 0.0001).

DISCUSSION

Our results confirm sNfL as prognostic biomarker for GBS and the precision was improved using the age-adjusted sNfL Z score. NfL index and Qalb are potential diagnostic biomarkers for GBS.

摘要

背景

神经丝轻链（NfL）水平升高与吉兰-巴雷综合征（GBS）的预后较差有关。我们的目的是确定血清 NfL（sNfL）、脑脊液（CSF）/血清 NfL 比值和 NfL 指数作为 GBS 的预后和诊断生物标志物的效用。

方法

我们测量了 1989 年至 2014 年间在瑞典西部的 96 名 GBS 患者的血清和/或 CSF 中的 NfL。计算了 sNfL Z 分数、NfL 比值和 NfL 指数。使用 GBS 残疾量表（GBSDS）在 3 个月和 12 个月时确定结局。将 GBS 中的 NfL 参数与健康对照（HC）、多发性硬化症（MS）和肌萎缩侧索硬化症（ALS）进行比较。

结果

3 个月时 GBSDS>2 的 sNfL Z 评分较高（中位数[IQR]，3.5ng/L[3.2-4.0]，vs 2.6[1.7-3.4]，p=0.008），12 个月时 GBSDS>2 的 sNfL Z 评分较高（3.6ng/L[3.5-3.8]，vs 2.6[1.8-3.5]，p=0.049）。NfL 比值和指数与结局无关。sNfL Z 评分的曲线下面积（AUC）为 0.76（95%CI 0.58-0.93，p<0.0001），用于预测 3 个月时 GBSDS>2。GBS 的 NfL 比值和指数均低于 HC、MS 和 ALS。NfL 比值的 AUC 为 0.66（95%CI 0.55-0.78，p=0.0018），NfL 指数的 AUC 为 0.86（95%CI 0.78-0.93，p<0.0001）。