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Neurology:湘雅医院发现NfL或能成为脊髓小脑共济失调的生物标志物

2021-01-02 MedSci原创 MedSci原创

NfL或能成为脊髓小脑共济失调的生物标志物

脊髓小脑性共济失调(Spinocerebellar ataxia type 3,SCA3)是最常见的常染色体显性遗传性共济失调。鉴于 SCA3的缓慢进展和表型变异性,寻找敏感和客观的疾病严重性和进展的生物标志物对于 SCA3的临床治疗和未来的治疗发展至关重要。神经丝轻链蛋白(NfL)是神经丝三个亚单位中最小的一个。最近的研究已经证实血清或血浆 NfL可作为一个有用的神经轴突损伤标志物,去评估许多神经退行性疾病的疾病严重性和进展。
 
神经病理学和神经影像学研究已经证实,在 SCA3中存在广泛的神经轴突损伤。因此,可以合理地假设 NfL 可能是 SCA3神经轴突损伤和疾病严重程度的一个潜在的生物标志物。此外,先前的一项研究发现 SCA3患者血清 NfL (sNfL)水平升高,进一步支持了这一假设。
 
中南大学湘雅医院的Yun Peng等人,探究了在SCA3的不同阶段的血清NfL 水平的分布,并确定它们是否与疾病严重程度有关。
 
在此横向研究中,他们纳入了185名健康对照者和235名 ATXN3基因突变携带者(无症状期17例,临床前期20例,共济失调期198例)。用单分子阵列(Simoa)平台测量了 sNfL 浓度。采用共济失调评定量表(SARA)和非共济失调体征量表(INAS)评定临床疾病严重程度。在50例共济失调期患者中,通过 MRI 进一步评估了灰质体积和白质纤维的完整性。
结果发现,无症状、临床前和共济失调 ATXN3基因突变携带者的 sNfL 浓度均高于对照组(12.18[10.20-13.92] ,21.84[18.37-23.45] ,36.06[30.04-45.90] ,8.24[5.92-10.84] pg/mL,所有p < 0.001)。sNfL 与 SARA 相关(p < 0.0001) ,与 INAS 相关(p < 0.0001) ,经年龄和 CAG 重复调整后仍有显著性差异。此外,我们还观察到 sNfL 与左中央前回和左中央旁小叶的灰质体积、平均扩散系数(mean diffusivity)呈负相关。
 
这个研究的新颖之处在于,发现了sNfL 水平在 SCA3中升高,并与临床疾病严重程度相关,这意味着sNfL 或许能作为 SCA3中疾病严重程度的生物标志物。
 
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    2021-04-02 yinhl1978
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    2021-01-03 xiaoyeshuang
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    2021-01-02 我们的祖国像花园

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