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JNNP:脑脊液鞘磷脂:一种新的脱髓鞘生物标志物在CIDP和GBS的诊断和治疗中的应用

2020-10-31 MedSci原创 MedSci原创

目的:慢性炎性脱髓鞘性多神经根神经病(CIDP)和格林-巴利综合征(GBS)是获得性免疫介导的神经病变,在临床表现、预后和治疗反应方面具有很强的异质性。它们属于罕见病而且可治疗,早期识别至关重要。作者

目的:慢性炎性脱髓鞘性多神经根神经病(CIDP)和格林-巴利综合征(GBS)是获得性免疫介导的神经病变,在临床表现、预后和治疗反应方面具有很强的异质性。它们属于罕见病但是可治疗,因此早期识别至关重要。作者验证患者脑脊液中鞘磷脂(SM)是慢性炎性脱髓鞘性多神经根性神经病(CIDP)和格林-巴雷综合征(GBS)是一个可靠的生物标志物。 

方法:作者前瞻性地收集了来自6个意大利转诊中心的184名患者,脑脊液SM水平通过实验室优化并进行荧光分析法进行定量分析。临床收集的1毫升脑脊液立即储存在−80°C下进行SM测试,以保持脂质和蛋白质的完整性。

结果:证实典型CIDP(n=35)、非典型CIDP(n=18)和急性炎症性脱髓鞘多神经根神经病(AIDP)(n=12)患者脑脊液中SM水平高于非脱髓鞘神经疾病患者(n=85)(p<0.0001,p=0.0065 和p<0.0001)。在按疾病分期分类的CIDP患者中,活动性CIDP患者的SM高于对照组和稳定CIDP(p<0.0001)。与轴索性GBS相比,AIDP中的SM也增加,可以区分脱髓鞘和轴突变异。SM与脑脊液蛋白水平无关,独立于常用的脑脊液指标对患者进行分类诊断,并显示出较高的特异性从而避免可能存在的误诊。

结论:CSF-SM是获得性脱髓鞘性神经病变的诊断和分期的生物标志物,可有效改善GBS和CIDP患者的治疗。

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    2020-12-15 kcb069
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    2021-02-22 xlxchina
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    2021-07-11 一叶知秋
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