肾功能对多发性硬化症患者血清神经丝水平的影响：一项探索性分析。

Renal function's impact on serum neurofilament levels in patients with multiple sclerosis: an exploratory analysis.

作者信息

Tortosa-Carreres Jordi, Cubas-Núñez Laura, Sanz Maria Teresa, Castillo-Villalba Jessica, Gasqué-Rubio Raquel, Carratalá-Boscá Sara, Alcalá-Vicente Carmen, Quintanilla-Bordás Carlos, Gorriz David, Casanova Bonaventura, Laiz-Marro Begoña, Pérez-Miralles Francisco

机构信息

Clinical Laboratory Department, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, Quatre Carreres, Valencia, 46026, Spain.

Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.

出版信息

Neurol Sci. 2025 Feb;46(2):845-853. doi: 10.1007/s10072-024-07772-6. Epub 2024 Sep 23.

DOI:10.1007/s10072-024-07772-6

PMID:39307881

Abstract

BACKGROUND

sNfL, a promising biomarker for neuroaxonal damage in Multiple Sclerosis (MS), requires cautious interpretation due to several comorbidity influences.

OBJECTIVES

To investigate the impact of renal function on sNfL levels in MS patients.

METHODS

This retrospective study stratified patients by MS clinical phenotype, acute inflammatory activity (AIA) status-defined as relapse or gadolinium-enhancing lesions within 90 days of sample collection-renal function, assessed by estimated glomerular filtration rate (eGFR), and age (< 40 years, 40-60 years, > 60 years). Comparative analysis of sNfL levels across these groups was performed. The sNfL-eGFR relationship was examined using linear and non-linear regression models, with the best fit determined by R and the F estimator.

RESULTS

Data from 2933 determinations across 800 patients were analyzed. Patients with renal insufficiency (RI) (eGFR < 60 mL/min/1.73 m) and mild renal impairment (MDRF) (eGFR 60-90 mL/min/1.73 m) showed significantly higher sNfL levels compared to those with normal renal function, a pattern also observed in age groups 40 years and older. No significant differences were found between MDRF patients and those with AIA. Among RI patients, no differences in sNfL levels were observed between relapsing-remitting and progressive MS phenotypes. A regression S-Curve model was identified as the best fit, illustrating a marked increase in sNfL levels beginning at an eGFR of approximately 75 mL/min/1.73 m.

DISCUSSION

Caution is advised when interpreting sNfL levels for monitoring MS in patients with impaired renal function.

摘要

背景

可溶性神经丝轻链（sNfL）是多发性硬化症（MS）神经轴突损伤的一种有前景的生物标志物，但由于多种合并症的影响，需要谨慎解读。

目的

研究肾功能对MS患者sNfL水平的影响。

方法

这项回顾性研究根据MS临床表型、急性炎症活动（AIA）状态（定义为样本采集后90天内的复发或钆增强病灶）、通过估计肾小球滤过率（eGFR）评估的肾功能以及年龄（<40岁、40 - 60岁、>60岁）对患者进行分层。对这些组间的sNfL水平进行比较分析。使用线性和非线性回归模型检查sNfL与eGFR的关系，通过R和F估计量确定最佳拟合。

结果

分析了800例患者的2933次检测数据。肾功能不全（RI）（eGFR < 60 mL/min/1.73 m²）和轻度肾功能损害（MDRF）（eGFR 60 - 90 mL/min/1.73 m²）的患者与肾功能正常的患者相比，sNfL水平显著更高，40岁及以上年龄组也观察到这种模式。MDRF患者与AIA患者之间未发现显著差异。在RI患者中，复发缓解型和进展型MS表型的sNfL水平未观察到差异。确定回归S曲线模型为最佳拟合，表明从eGFR约75 mL/min/1.73 m²开始，sNfL水平显著升高。