神经丝轻链蛋白和炎症细胞因子对临床孤立综合征复发的预测价值

Predictive value of neurofilament light chain proteins and inflammatory cytokines for relapse of clinically isolated syndrome

目的:探讨神经丝轻链蛋白(NfL)和辅助T细胞17(Th17)相关炎症细胞因子与临床孤立综合征(CIS)发病及在复发与转归为多发性硬化(MS)的预测价值。方法:纳入96例CIS患者为CIS组,30例性别、年龄相匹配的神经系统非炎症疾病(NIND)患者为对照组,采用酶联免疫吸附试验法检测所纳入研究者和首次复发为MS患者血清和脑脊液中NfL和Th17相关炎症细胞因子IL-17A、IL-23、IL-21、IL-22、TGF-β、IL-6水平。结果:中位随访24.07个月后转归为MS 57例(59.38%)。与对照组比较,CIS组血清和脑脊液中NfL、IL-17A、IL-23、IL-21、IL-22水平增高,血清和脑脊液中TGF-β,脑脊液中IL-6减低;与未复发CIS患者比较,转归为MS患者基线脑脊液中NfL、IL-17A、IL-23水平增高;复发后脑脊液中NfL,血清和脑脊液中IL-17A、IL-23水平增高,差异均有统计学意义;CIS、转化为MS患者NfL与Th17相关炎症细胞因子无相关性。结论:脑脊液中NfL,血清和脑脊液中IL-17A、IL-23水平是预测CIS复发的潜在标志物。未发现NfL与Th17相关炎症细胞因子的相关性。

Objective:To investigate the predictive value of neurofilament light chain proteins(NfL)and helper T-cell 17(Th17)-related inflammatory cytokines for the onset of clinically isolated syndrome(CIS)and its relapse and conversion to multiple sclerosis(MS).Methods:Ninety-six CIS patients were selected as the treatment group,30 sex-and age-matched patients with non-inflammatory neurological disease(NIND)as the control group.Serum and cerebrospinal fluid levels of NfL and Th17-related inflammatory cytokines IL-17A,IL-23,IL-21,IL-22,TGF-β,and IL-6 in the selected subjects and patients with first relapse of MS were measured using enzyme-linked immunosorbent assay.Results:After a median follow-up of 24.07 months,57 cases(59.38%)converted to MS.Compared with NIND,patients with CIS had increased levels of NfL,IL-17A,IL-23,IL-21,IL-22in serum and cerebrospinal fluid,decreased TGF-βin serum and cerebrospinal fluid,and decreased IL-6 in cerebrospinal fluid;compared with patients with non-recurrent CIS,patients who converted to MS had increased levels of NfL,IL-17A,IL-23 in cerebrospinal fluid at baseline;after relapse,levels of NfL in cerebrospinal fluid and IL-17A and IL-23 in serum and cerebrospinal fluid increased with statistical significance;there was no correlation between NfL and Th17-related inflammatory cytokines in patients with CIS and conversion to MS.Conclusion:NfL in cerebrospinal fluid and IL-17A and IL-23 levels in serum and cerebrospinal fluid are potential markers for predicting CIS relapse.No correlation between NfL and Th17-related inflammatory cytokines was found.