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.
J Neurol. 2024 Nov;271(11):7282-7293. doi: 10.1007/s00415-024-12679-5. Epub 2024 Sep 9.
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.
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).
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).
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.
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。
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。
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）。
我们的结果证实 sNfL 是 GBS 的预后生物标志物，使用年龄调整的 sNfL Z 评分可提高其精度。NfL 指数和 Qalb 可能是 GBS 的潜在诊断生物标志物。
