帕金森病患者快速眼动睡眠行为障碍与血浆神经丝轻链水平的临床分析

Clinical analysis of rapid eye movement sleep behavior disorder and plasma neurofilament light chain levels in patients with Parkinson's disease

目的探讨帕金森病(PD)患者的快速眼球运动睡眠行为障碍(RBD)与血浆神经丝轻链水平(NfL)的关系。方法采用前瞻性研究的方法,连续收集2019年6月至2021年1月在昆明医科大学第一附属医院老年神经内科就诊的121例PD患者和38例健康对照组的一般临床资料、相关量表评分以及血浆NfL水平,根据快速眼动睡眠期行为障碍量表(RBDSQ将帕金森病患者分为PD合并RBD组(PD-RBD,RBDSQ≥6)与PD不伴RBD组(PD-NRBD,RBDSQ<6)。比较三组患者的一般临床资料、血浆NfL水平,比较PD-RBD和PD-NRBD组患者的运动及非运动症状、睡眠质量等。结果PD组的血浆NfL水平高于对照组,M(Q1,Q3)分别为19.39(12.58,31.78)、14.85(9.78,22.15)ng/L(Z=-2.492,P<0.05),PD-RBD组的血浆NfL水平高于PD-NRBD组以及对照组,M(Q1,Q3)分别为25.29(19.09,34.75)ng/L、17.14(11.70,26.67)ng/L、14.85(9.78,22.15)ng/L(Z=-3.434,P<0.01),但对照组和PD-NRBD组的血浆NfL水平差异无统计学意义(P>0.05)。受试者工作特征曲线(ROC)分析结果表明,血浆NfL浓度为17.86μg/L时,可区分PD-RBD组和PD-NRBD组(曲线下面积为0.70,95%CI:0.60~0.80,灵敏度82%,特异度54%)。二元Logistic回归分析显示,血浆NfL水平是PD伴RBD的独立危险因素(β=0.068,OR=1.103,P=0.003)。结论PD-RBD患者的血浆NfL水平增高,血浆NfL或可作为PD合并RBD的潜在生物标记物。

ObjectiveTo investigate the relationship between rapid eyemovement sleep behavior disorder(RBD)and neurofilament light chain(NfL)levels in patients with Parkinson's disease(PD).MethodsGeneral clinical data of 121 PD patients and 38 healthy controls(HC)who visited the Department of Geriatric Neurology of the First Affiliated Hospital of Kunming Medical University from June 2019 to January 2021 were collected in a prospective study.According to the Rapid Eye Movement Sleep Behavior Disorder Questionnaire(RBDSQ),PD patients were divided into a PD with RBD group(PD-RBD,RBDSQ≥6)and a PD without RBD group(PD-NRBD,RBDSQ<6).General clinical data and plasma NfL levels of patients in the groups were compared.In addition,symptoms during exercise,during non-exercise,and sleep quality in the groups were also compared.Results.Plasma NfL levels were higher in the PD group than in the HC group(19.39 ng/L,12.58-31.78;14.85 ng/L,9.78-22.15;Z=-2.492,P<0.05);plasma NfL levels were significantly higher in the PD-RBD group than in the PD-NRBD group and in the HC group(25.29 ng/L,19.09-34.75;17.14 ng/L,11.70-26.67;14.85 ng/L,9.78-22.15;Z=3.434,P<0.01);there was no significant dfference in plasma NfL levels between the HC group and the PD-NRBD group(P>0.05).Receiver operating characteristic(ROC)curve analysis showed that,when the plasma NfL,cutoff was set at 17.86 ng/L,PD-RBD and PD-NRBD could be distinguished(AUC=0.70,95%CI=0.60-0.80,sensitivity 82%,specificity 54%).Binary logistic regression identified NfL level as an independent predictor of PD-RBD(β=0.068,OR=1.103,P=0.003).ConclusionsPD-RBD patients have increased plasma NfL levels which can potentilly serve as a biomarker for PD with RBD.