Serum NFL discriminates Parkinson disease from atypical parkinsonisms
Serum NFL discriminates Parkinson disease from atypical parkinsonisms
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DOI：
10.1212/wnl.0000000000007179
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发表时间：
2019-03-26
期刊：
影响因子：
9.9
通讯作者：
Verbeek, Marcel M.
中科院分区：
文献类型：
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作者：
Marques, Taina M.;van Rumund, Anouke;Verbeek, Marcel M.
目的探讨血清神经丝轻链（NFL）在帕金森症状明确但尚未明确诊断的患者中的诊断价值。方法对有明显帕金森症状但诊断不明确的患者进行血清采集。帕金森病（PD）和非典型帕金森病（APDs）的临床诊断是在3年随访后确定的，如果有更长的随访数据，则最多在12年后再次更新。采用单分子阵列法对PD（55例）、APD（29例，多系统萎缩22例，进行性核上性麻痹7例）和53例非神经系统对照的血清NFL进行定量分析。结果血清NFL水平升高，将APD组（平均23.8 +/- 10.3 ng/L）与PD组（平均10.4 +/- 4.9 ng/L）和对照组（平均11.5 +/- 6.5 ng/L, p < 0.0001）区分，准确率高达91%（敏感性= 86%，特异性= 85%）。血清NFL与各组脑脊液NFL水平（r = 0.72, p < 0.0001）、PD组（r = 0.78, p < 0.0001）和对照组（r = 0.66, p < 0.0001）的年龄密切相关。在我们的队列中，患APD的概率为76%（阳性预测值），患PD的概率为92%（阴性预测值）。结论APD患者血清NFL水平明显高于PD，具有较高的区分APD与PD的准确性。血清NFL可能是识别APD的一个有用的临床生物标志物，即使在临床症状尚未确定的阶段。本研究提供了血清NFL水平能够准确区分apd和PD的II级证据。
Objective To investigate the diagnostic value of serum neurofilament light chain (NFL) in patients with clear signs of parkinsonism but whose specific diagnosis was yet uncertain. Methods Serum samples were collected from patients with clear signs of parkinsonism but with uncertain diagnosis at the inclusion. Clinical diagnoses of Parkinson disease (PD) and atypical parkinsonism disorders (APDs) were established after 3 years of follow-up and updated again after a maximum of 12 years in case longer follow-up data were available. Serum NFL was quantified by single molecule array in patients with PD (n = 55) and APD (n = 29, multiple system atrophy = 22, progressive supranuclear palsy = 7) and 53 nonneurologic controls. Results Serum NFL levels were elevated and differentiated the APD group (mean 23.8 +/- 10.3 ng/L) from PD (mean 10.4 +/- 4.9 ng/L) and controls (mean 11.5 +/- 6.5 ng/L, p < 0.0001) with accuracy levels up to 91% (sensitivity = 86% and specificity = 85%). Serum NFL strongly correlated with CSF NFL levels (r = 0.72, p < 0.0001) in all groups and with age in PD (r = 0.78, p < 0.0001) and controls (r = 0.66, p < 0.0001). In our cohort, the probability of having APD was 76% (positive predictive value) and of having PD 92% (negative predictive value). Conclusion Serum NFL levels are markedly elevated in APD compared to PD and discriminate APDs from PD with high accuracy. Serum NFL may be a useful clinical biomarker to identify APD, even at stages when clinical symptoms are not yet conclusive. Classification of evidence This study provides Class II evidence that serum NFL levels accurately discriminate APDs from PD.