Baidu
map

JNNP:血清神经丝轻链水平预测进行性多发性硬化患者的长期残疾进展

2022-06-14 网络 网络

神经丝是神经元损伤后释放到细胞外空间的神经元特异性细胞骨架蛋白。在这种情况下,细胞外液、脑脊液(CSF)和外周血中神经丝的浓度可以反映病理过程中神经轴突损伤的程度。据报道,在广泛的神经炎症和神经退行性

神经丝是神经元损伤后释放到细胞外空间的神经元特异性细胞骨架蛋白。在这种情况下,细胞外液、脑脊液(CSF)和外周血中神经丝的浓度可以反映病理过程中神经轴突损伤的程度。据报道,在广泛的神经炎症和神经退行性疾病中,脑脊液和血液中的神经丝轻链(NfL)水平升高。在多发性硬化症(MS)中,NfL被认为是神经元损伤的高度敏感生物标志物。对于复发性MS患者,NfL作为疾病活动和治疗反应的生物标志物的预后作用已被彻底研究。

在这方面,复发期间CSF和/或血液NfL水平升高,并与MRI T2病变数量和T1病变增强相关;它们是临床和放射学孤立综合征患者向临床明确的MS过渡的危险因素;需要预测未来MRI病变情况、脑和脊髓体积损失、复发率和扩展残疾状态量表(EDSS)的恶化;它们与接受疾病改良治疗的患者的临床和MRI结果相关。在进行性MS患者中,NfL作为残疾进展的生物标志物的预后作用更为难以捉摸。在本研究中,旨在评估血清NfL(sNfL)水平作为进展性MS患者队列中短期、中期和长期残疾进展的预后生物标志物的潜力。本文发表在《神经病学,神经外科学和精神病学杂志》上().

对51名进行性MS患者进行了前瞻性观察队列研究,这些患者参与了为期2年的干扰素β单中心、随机、双盲、安慰剂对照试验。平均(SD)随访时间为13.9(6.2)年。在基线、1年、2年和6年时,使用单分子阵列免疫分析法测量sNfL水平。进行单变量和多变量分析,以评估sNfL水平与短期(2年)、中期(6年)和长期(最后一次随访时)残疾进展之间的相关性。患者每3个月随访一次 2个月 在试验期间,每6个月一次,直到最后一次随访,使用EDSS记录残疾数据。短期残疾进展的定义是,如果基线EDSS为1分,EDSS中至少增加1分≤5.0,如果基线EDSS为0.5分≥5.5在2年的试验期间。考虑到大多数患者在中长期都会达到这一进展标准,为了评估这些时间点的残疾进展,通过将EDSS变化除以试验基线和6年(中期)之间以及试验基线和最后就诊时间(长期)之间的随访时间来计算进展率。对于所有残疾进展指标,EDSS评分在6个月时得到确认。

进行性MS患者基线时sNfL水平的表现,以区分短期、中期和长期的进行性MS患者和非进行性MS患者

进行性MS患者的sNfL中值水平为9.1 微克/毫升(IQR 7.5–13.7 pg/mL)。在单变量分析中,基线sNfL水平与样本采集时的二次型年龄相关(β:1.48;95%可信区间0.54至2.41;p=0.002),但与性别无关。基线sNfL水平与疾病持续时间、临床形式或EDS无关。29例(57%)患者在前2个月接受了干扰素β治疗 作为临床试验一部分的随访年数。只有5名(9.8%)患者,其中4名来自治疗组,1名来自安慰剂组,在试验完成后接受了干扰素β的免疫调节治疗。从试验结束到最后一次就诊,研究中包括的其余进行性MS患者均未接受治疗。在单变量分析中,IFNβ治疗在短期内没有改变EDSS轨迹(β:0.002;95% CI公司−0.01至0.01;p=0.73),中期(β:−0.006; 95% CI公司−0.01至0;p=0.33)或长期(β:−0.002; 95% CI公司−0.004至0;p=0.40)。在调整年龄和性别后,在多变量分析中也获得了类似的结果(数据未显示)。在2年的治疗期间,干扰素β略微降低sNfL水平(β:−0.13; 95% CI公司−0.19至–0.07;p=0.02)。

sNfL水平在基线时的表现,以根据健康对照组NDB得出的sNfL Z评分预测短期、中期和长期残疾进展

在短期和中期,进展者和非进展者之间的基线sNfL水平没有显著差异;同样,在这些时间点,基线sNfL水平在区分进步者和非进步者方面表现不佳。相比之下,长期进展患者的基线sNfL水平显著升高(p=0.03),单变量分析中sNfL浓度为10.2 pg/mL是区分长期进展者和非进展者的最佳分界点,敏感性为75%,特异性为67%,PPV和NPV分别为42.9%和88.9%。在调整后的logistic回归中,基线sNfL高于10.2 pg/mL仍然是预测长期残疾进展的重要危险因素(OR 7.8;95% CI 1.8至46.4;p=0.01)。

CSF或血液NfL水平作为进行性MS患者残疾进展的生物标志物的作用甚至更不明确,大多数研究显示为阴性结果。此外,没有研究评估这组患者的NfL水平与长期残疾进展之间的关系。在这项研究中,旨在通过研究sNfL水平与进行性MS患者试验队列中短期、中期和长期残疾进展之间的关系来填补这一空白,这些患者平均随访14年。短期残疾进展是根据EDSS变化来定义的,而中期和长期残疾进展是根据进展率和随后选择的残疾进展分布在第75百分位以上的患者来定义的。尽管57%的患者在2年试验期间接受了干扰素β治疗,但绝大多数患者(90%)在试验结束后的剩余时间内未接受治疗。此外,IFNβ对sNfL水平几乎没有影响,并且在短期、中期或长期对EDSS轨迹没有影响。其他研究表明,IFNβ治疗可降低sNfL水平,15或无显著影响。如先前研究所示,基线sNfL水平受年龄影响;然而,基线sNfL水平与性别、临床形式(患者是否患有原发性进行性或过渡性进行性MS)或EDS无关。

sNfL可被视为进展性MS患者未来长期残疾进展的预后生物标志物。这些数据扩展了关于sNfL作为进展性MS患者长期预后生物标志物作用的现有知识。

Comabella MSastre-Garriga JCarbonell-Mirabent P, et al Serum neurofilament light chain levels predict long-term disability progression in patients with progressive multiple sclerosis

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1969602, encodeId=31dc1969602c4, content=<a href='/topic/show?id=89326345995' target=_blank style='color:#2F92EE;'>#残疾进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63459, encryptionId=89326345995, topicName=残疾进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55f6293, createdName=lishizhe, createdTime=Sun Oct 09 16:43:06 CST 2022, time=2022-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976665, encodeId=130819e6665c2, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Sun Jun 12 22:43:06 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935038, encodeId=070f19350380e, content=<a href='/topic/show?id=df6ee41476f' target=_blank style='color:#2F92EE;'>#神经丝轻链#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74147, encryptionId=df6ee41476f, topicName=神经丝轻链)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Tue May 23 13:43:06 CST 2023, time=2023-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1801711, encodeId=43d11801e111a, content=<a href='/topic/show?id=91f1e4142bd' target=_blank style='color:#2F92EE;'>#神经丝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74142, encryptionId=91f1e4142bd, topicName=神经丝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Tue Feb 21 10:43:06 CST 2023, time=2023-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1890381, encodeId=76dd1890381db, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Sun Apr 02 08:43:06 CST 2023, time=2023-04-02, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1969602, encodeId=31dc1969602c4, content=<a href='/topic/show?id=89326345995' target=_blank style='color:#2F92EE;'>#残疾进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63459, encryptionId=89326345995, topicName=残疾进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55f6293, createdName=lishizhe, createdTime=Sun Oct 09 16:43:06 CST 2022, time=2022-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976665, encodeId=130819e6665c2, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Sun Jun 12 22:43:06 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935038, encodeId=070f19350380e, content=<a href='/topic/show?id=df6ee41476f' target=_blank style='color:#2F92EE;'>#神经丝轻链#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74147, encryptionId=df6ee41476f, topicName=神经丝轻链)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Tue May 23 13:43:06 CST 2023, time=2023-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1801711, encodeId=43d11801e111a, content=<a href='/topic/show?id=91f1e4142bd' target=_blank style='color:#2F92EE;'>#神经丝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74142, encryptionId=91f1e4142bd, topicName=神经丝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Tue Feb 21 10:43:06 CST 2023, time=2023-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1890381, encodeId=76dd1890381db, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Sun Apr 02 08:43:06 CST 2023, time=2023-04-02, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1969602, encodeId=31dc1969602c4, content=<a href='/topic/show?id=89326345995' target=_blank style='color:#2F92EE;'>#残疾进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63459, encryptionId=89326345995, topicName=残疾进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55f6293, createdName=lishizhe, createdTime=Sun Oct 09 16:43:06 CST 2022, time=2022-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976665, encodeId=130819e6665c2, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Sun Jun 12 22:43:06 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935038, encodeId=070f19350380e, content=<a href='/topic/show?id=df6ee41476f' target=_blank style='color:#2F92EE;'>#神经丝轻链#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74147, encryptionId=df6ee41476f, topicName=神经丝轻链)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Tue May 23 13:43:06 CST 2023, time=2023-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1801711, encodeId=43d11801e111a, content=<a href='/topic/show?id=91f1e4142bd' target=_blank style='color:#2F92EE;'>#神经丝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74142, encryptionId=91f1e4142bd, topicName=神经丝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Tue Feb 21 10:43:06 CST 2023, time=2023-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1890381, encodeId=76dd1890381db, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Sun Apr 02 08:43:06 CST 2023, time=2023-04-02, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1969602, encodeId=31dc1969602c4, content=<a href='/topic/show?id=89326345995' target=_blank style='color:#2F92EE;'>#残疾进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63459, encryptionId=89326345995, topicName=残疾进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55f6293, createdName=lishizhe, createdTime=Sun Oct 09 16:43:06 CST 2022, time=2022-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976665, encodeId=130819e6665c2, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Sun Jun 12 22:43:06 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935038, encodeId=070f19350380e, content=<a href='/topic/show?id=df6ee41476f' target=_blank style='color:#2F92EE;'>#神经丝轻链#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74147, encryptionId=df6ee41476f, topicName=神经丝轻链)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Tue May 23 13:43:06 CST 2023, time=2023-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1801711, encodeId=43d11801e111a, content=<a href='/topic/show?id=91f1e4142bd' target=_blank style='color:#2F92EE;'>#神经丝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74142, encryptionId=91f1e4142bd, topicName=神经丝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Tue Feb 21 10:43:06 CST 2023, time=2023-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1890381, encodeId=76dd1890381db, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Sun Apr 02 08:43:06 CST 2023, time=2023-04-02, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1969602, encodeId=31dc1969602c4, content=<a href='/topic/show?id=89326345995' target=_blank style='color:#2F92EE;'>#残疾进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63459, encryptionId=89326345995, topicName=残疾进展)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55f6293, createdName=lishizhe, createdTime=Sun Oct 09 16:43:06 CST 2022, time=2022-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976665, encodeId=130819e6665c2, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Sun Jun 12 22:43:06 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935038, encodeId=070f19350380e, content=<a href='/topic/show?id=df6ee41476f' target=_blank style='color:#2F92EE;'>#神经丝轻链#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74147, encryptionId=df6ee41476f, topicName=神经丝轻链)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Tue May 23 13:43:06 CST 2023, time=2023-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1801711, encodeId=43d11801e111a, content=<a href='/topic/show?id=91f1e4142bd' target=_blank style='color:#2F92EE;'>#神经丝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74142, encryptionId=91f1e4142bd, topicName=神经丝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Tue Feb 21 10:43:06 CST 2023, time=2023-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1890381, encodeId=76dd1890381db, content=<a href='/topic/show?id=760c430895a' target=_blank style='color:#2F92EE;'>#多发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43089, encryptionId=760c430895a, topicName=多发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04d6114, createdName=jml2009, createdTime=Sun Apr 02 08:43:06 CST 2023, time=2023-04-02, status=1, ipAttribution=)]
    2023-04-02 jml2009

相关资讯

Ann Neurol:端粒长度与多发性硬化症的残疾进展有关

由此可见,短期端粒长度与残疾相关,与实际年龄无关,提示生物衰老可能导致MS的神经损伤。针对衰老相关机制是预防MS进展的潜在治疗策略。

Neurology:儿童发病的多发性硬化症患者长期残疾进展

由此可见,儿童发病的MS患者遵循独特的临床过程,应该在疾病的治疗和管理中加以考虑。

JAMA:β干扰素不能减缓多发性硬化残疾进展

    《美国医学会杂志》(JAMA)7月18日发表的一项基于前瞻性数据的回顾性队列研究显示,β干扰素治疗不能减缓复发缓解型多发性硬化(MS)成人患者的远期残疾进展(JAMA 2012;308:247-56)。    这项研究由加拿大温哥华海岸卫生研究所大脑研究中心的Afsaneh Shirani博士及其同事进行,共对3组患者的预后进行了分析。 

Neurology:身体合并症对多发性硬化患者残疾进展的影响!

由此可见,身体合并症与MS残疾进展明显加快有关。需要适当的合并症治疗以优化患者结局。

JNNP:应用灰质容积模式预测多发性硬化患者的残疾进展和认知恶化

多发性硬化症(MS)是一种中枢神经系统的炎症性和神经退行性疾病。MS最常见的病理特征是炎症性脱髓鞘白质(WM)病变。然而,不可逆残疾和进行性MS的主要致病因素被认为是神经退行性变。 现在有许多治疗方法

Baidu
map
Baidu
map
Baidu
map