Paul Julien F, Ducroux Célina, Correia Pamela, Daigneault Audrey, Larochelle Catherine, Stapf Christian, Gioia Laura C
Department of Neurosciences, University of Montreal, Montréal, QC, Canada.
Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
Front Neurol. 2024 Dec 6;15:1470718. doi: 10.3389/fneur.2024.1470718. eCollection 2024.
Interest is emerging regarding the role of blood biomarkers in acute stroke. The aim of this pilot study was to determine the feasibility of biomarker acquisition in suspected acute stroke, using modern ultrasensitive immunoassay techniques, and explore their potential usefulness for stroke diagnosis and management.
In 62 patients with suspected acute stroke, blood samples were prospectively obtained upon arrival and prior to neuroimaging. Serum levels of glial fibrillary acidic protein (sGFAP) and neurofilament light chain (sNfL) were analyzed using a single molecule array (SIMOA) method, according to time of symptom onset, neuroimaging, and final diagnosis.
Acute ischemic stroke (AIS) was diagnosed in 35 patients, 10 with large-vessel occlusion (LVO). The remaining were diagnosed with intracerebral hemorrhage (ICH) ( = 12), transient ischemic attack ( = 4), and stroke mimics ( = 11). Median (IQR) sGFAP levels were significantly higher in ICH (2,877.8 [1,002.1-10,402.5] pg./mL) compared to others diagnoses. In AIS, GFAP levels appear to increase with longer delays since symptom onset and were higher in patients with more extensive ischemic changes on baseline CT (ASPECTS ≤7) than those without, particularly in LVO stroke. NfL values were similar across groups.
In acute stroke, serum GFAP levels show potential as an adjunct tool for the distinction between ICH and AIS. Specific to AIS, GFAP may also offer insight into time from onset, and extent of ischemic tissue injury on neuroimaging, particularly in LVO stroke. These preliminary findings merit further study.
血液生物标志物在急性卒中中的作用正受到越来越多的关注。这项初步研究的目的是确定使用现代超灵敏免疫测定技术在疑似急性卒中患者中获取生物标志物的可行性，并探讨其在卒中诊断和管理中的潜在用途。
对62例疑似急性卒中患者，在入院时和神经影像学检查前前瞻性采集血样。根据症状发作时间、神经影像学检查和最终诊断，采用单分子阵列（SIMOA）方法分析血清胶质纤维酸性蛋白（sGFAP）和神经丝轻链（sNfL）水平。
35例患者被诊断为急性缺血性卒中（AIS），其中10例为大血管闭塞（LVO）。其余患者被诊断为脑出血（ICH）（n = 12）、短暂性脑缺血发作（n = 4）和类卒中（n = 11）。与其他诊断相比，ICH患者的sGFAP水平中位数（IQR）显著更高（2,877.8 [1,002.1 - 10,402.5] pg./mL）。在AIS患者中，GFAP水平似乎随着症状发作后延迟时间的延长而升高，并且在基线CT上缺血改变更广泛（ASPECTS≤7）的患者中高于无此改变者，尤其是在LVO卒中患者中。各亚组的NfL值相似。
在急性卒中中，血清GFAP水平有望作为区分ICH和AIS的辅助工具。对于AIS，GFAP还可能有助于了解发病时间以及神经影像学上缺血组织损伤的程度，尤其是在LVO卒中中。这些初步发现值得进一步研究。
