外周血神经丝轻链蛋白水平与急性脑梗死近期预后的相关性研究

Correlation between Peripheral Blood Neurofilament Light Chain Protein Levels and Short-Term Prognosis in Acute Cerebral Infarction Patients

目的:探讨急性脑梗死患者外周血神经丝轻链蛋白(NfL)水平与近期预后的相关性。方法:选取280例急性脑梗死患者作为病例组,选取同时期参加体检的280例志愿者作为对照组;搜集急性脑梗死患者和对照受试者临床资料,主要包括人口学特征、个人史、既往慢性疾病史、本次发病情况、影像学检查结果以及治疗经过。根据血NfL水平中位数将病例组患者分为NfL高水平组和NfL低水平组,比较2组性别、年龄、个人史、合并症、发病及预后情况的差异;比较不同个人史、合并症、美国国立卫生院卒中量表(NIHSS)评分、梗死体积和重组组织型纤溶酶原激活剂(rt-PA)治疗情况患者的外周血NfL水平的差异;并采用多元Logistic回归评估外周血NfL水平与急性脑梗死预后的相关性。结果:病例组外周血NfL水平(79.71±16.85)pg·mL^(-1)高于对照组的(25.25±7.17)pg·mL^(-1)(P<0.05);NfL高水平组与NfL低水平组在性别、年龄、体质指数、高脂血症史、冠心病史方面差异无统计学意义;NfL高水平组患者吸烟、饮酒、罹患高血压和2型糖尿病比例高于NfL低水平组;NfL高水平组患者NIHSS评分、梗死体积高于NfL低水平组(P<0.05),NfL高水平组患者发生认知功能障碍和日常活动能力受损的人数更多(P<0.05),而2组死亡人数差异无统计学意义(P>0.05);有吸烟史患者、脑梗死体积较大患者的血NfL水平高于无吸烟史、脑梗死体积较小患者,差异有统计学意义(P<0.05);多元Logistic回归分析显示,外周血NfL水平偏高与随访期间日常活动能力受损、认知功能障碍的发生风险增加存在相关性(P<0.05)。结论:偏高的外周血NfL水平与急性脑梗死后180 d内多种不良预后事件的发生有相关性,血NfL水平可能是急性脑梗死近期预后的潜在标记物。

Objective:To explore the relationship between peripheral neurofilament light chain(NfL)level and short-term prognosis in acute cerebral infarction patients.Methods:A total of 280 acute cerebral infarction patients were continuously included as a case group.During the same period,280 controls were collected from the department of medical examination of this hospital and served as a control group.Information on patients with acute cerebral infarction and control subjects was collected,including demographic information,personal history,history of previous chronic diseases,current onset,imaging examination results,and treatment history.Patients in the case group were divided into a high-level NfL group and a low-level NfL group based on median blood NfL levels,and baseline characteristics were compared between the high-level NfL group and the low-level NfL group.Patients in the case group were divided into subgroups based on personal history,chronic disease history,NIHSS score,infarct volume,and recombinant tissue-type plasminogen activator(rt-PA)treatment,and their peripheral blood NfL levels were compared,and the correlation between the peripheral blood NfL levels and with the prognosis of acute cerebral infarction was assessed using multivariate logistic regression.Results:The peripheral blood NfL levels of patients in the case group were higher than those in the control group(P<0.05).There were no statistically significant differences in gender,age,body mass index,history of hyperlipidemia,and history of coronary artery disease between the high-level NfL group and the low-level NfL group;the proportions of patients who smoked,drank alcohol,and developed hypertension and type 2 diabetes mellitus were higher in the high-level NfL group than in the low-level NfL group;and patients in the high-level NfL group had higher NIHSS scores and higher infarct volumes than those in the low-level NfL group(P<0.05).Cognitive dysfunction and impaired ability to perform daily activities occurred in a greater number of patients in the group with high levels of NfL(P<0.05),whereas the difference in the number of deaths was not statistically significant in the 2 groups(P>0.05).Blood NfL levels were higher in patients with a history of smoking and patients with larger cerebral infarct volumes than in patients with no smoking history and smaller cerebral infarct volumes,and the difference was statistically significant(P<0.05);multiple logistic regression showed that high peripheral blood NfL levels were correlated with an increased risk of impaired ability to perform activities of daily living and cognitive dysfunction during the follow-up period(P<0.05).Conclusion:High peripheral blood NfL levels showed an association with the occurrence of multiple adverse prognostic events within 180 days after acute cerebral infarction and blood NfL levels may be a potential predictive marker for the recent prognosis of acute cerebral infarction.