Blood-based NfL: A biomarker for differential diagnosis of parkinsonian disorder.
Blood-based NfL: A biomarker for differential diagnosis of parkinsonian disorder.
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DOI：
10.1212/wnl.0000000000003680
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发表时间：
2017-03-07
期刊：
影响因子：
9.9
通讯作者：
Swedish BioFINDER study
中科院分区：
文献类型：
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作者：
Hansson O;Janelidze S;Hall S;Magdalinou N;Lees AJ;Andreasson U;Norgren N;Linder J;Forsgren L;Constantinescu R;Zetterberg H;Blennow K;Swedish BioFINDER study
确定血液神经丝轻链（NfL）蛋白是否可以区分帕金森病（PD）和非典型帕金森病（APD），其诊断准确性与CSF NfL相同，因此可以改善帕金森病的诊断检查。该研究包括3个独立的前瞻性队列：隆德（n = 278）和伦敦（n = 117）队列，包括健康对照和PD、进行性核上性麻痹（PSP）、皮质基底综合征（CBS）和多系统萎缩（MSA）患者，以及疾病持续时间≤3年的PD、PSP、MSA或CBS患者的早期疾病队列（n = 109）。使用超灵敏单分子阵列（Simoa）方法测量血液NfL浓度，并研究区分PD和APD的诊断准确性。我们发现NfL的血液和CSF浓度之间存在强相关性（ρ ≥ 0.73-0.84，p ≤ 0.001）。血液NfL在MSA、PSP和CBS患者中增加（即，所有APD组）与所有队列中的PD患者以及健康对照相比时（p < 0.001）。此外，在隆德队列中，血液NfL可以准确区分PD和APD（曲线下面积[AUC] 0.91），伦敦队列（AUC 0.85）和早期疾病队列（AUC 0.81）的结果相似。血液NfL浓度的定量可用于区分PD与APD。基于血液的NfL可能因此被包括在诊断帕金森症状的患者在初级保健和专业诊所。这项研究提供了III类证据，证明血液NfL水平可区分PD和APD。
To determine if blood neurofilament light chain (NfL) protein can discriminate between Parkinson disease (PD) and atypical parkinsonian disorders (APD) with equally high diagnostic accuracy as CSF NfL, and can therefore improve the diagnostic workup of parkinsonian disorders. The study included 3 independent prospective cohorts: the Lund (n = 278) and London (n = 117) cohorts, comprising healthy controls and patients with PD, progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA), as well as an early disease cohort (n = 109) of patients with PD, PSP, MSA, or CBS with disease duration ≤3 years. Blood NfL concentration was measured using an ultrasensitive single molecule array (Simoa) method, and the diagnostic accuracy to distinguish PD from APD was investigated. We found strong correlations between blood and CSF concentrations of NfL (ρ ≥ 0.73–0.84, p ≤ 0.001). Blood NfL was increased in patients with MSA, PSP, and CBS (i.e., all APD groups) when compared to patients with PD as well as healthy controls in all cohorts (p < 0.001). Furthermore, in the Lund cohort, blood NfL could accurately distinguish PD from APD (area under the curve [AUC] 0.91) with similar results in both the London cohort (AUC 0.85) and the early disease cohort (AUC 0.81). Quantification of blood NfL concentration can be used to distinguish PD from APD. Blood-based NfL might consequently be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics. This study provides Class III evidence that blood NfL levels discriminate between PD and APD.