Stroke :新指标可区分自发性脊髓梗死和急性脊髓炎

2021-02-16 Freeman MedSci原创

新指标可区分自发性脊髓梗死和急性脊髓炎


自发性脊髓梗死(SCI)是一种致残性的急性脊髓病变的原因,且经常被低估,误诊的原因可能是由于相对罕见,临床和磁共振成像(MRI)特征经常与其他更常见的急性脊髓病变(特别是急性脊髓炎)的原因重叠,以及缺乏特定的生物标志物。

如果能识别患者就可将其纳入可能的临床试验,但诊断的不确定性是一个重要限制,所以目前还没有证实SCI的有效治疗方法。

虽然典型的SCI表现为超急性重症脊髓病变(4-12小时内)和特定的伴随性MRI特征(如脊髓病变的弥散加权成像局限),但建立一个明确的超急性表现并不总是直接的,约25%的病例在>12-24小时内有一个长期的、常常是阶梯性的表现,这在围手术期和自发性SCI中都有表现,这使得与急性脊髓炎的区分具有挑战性。

一个客观和广泛可用的生物标志物来区分SCI和其他原因,将有利于更快、更准确地识别患者,并避免在诊断不确定的情况下,经验性地尝试不必要的和潜在的有害治疗。


神经丝轻链(NfL)是神经元细胞骨架的主要成分,最近已成为各种神经系统疾病中神经轴损伤的一个有吸引力的生物标志物。许多研究表明,血清中的NfL水平在初始损伤的头几天增加,并保持约3个月的升高,反映了神经轴损伤的程度。

血清NfL水平强烈依赖于神经损伤的性质(例如,缺血性损伤很可能导致血清中NfL的释放,而非炎症)和范围(即,较大的病变释放更大量的NfL)。


藉此,美国著名Mayo Clinic的Elia Sechi 等人,研究了血清神经丝轻链水平与MRI T2病灶面积的比值(神经丝轻链/面积比值-NAR)是否能区分SCI与急性骨髓炎的相似严重程度。

他们回顾性地识别了梅奥诊所的患者(2000年1月1日-2019年12月31日),有(1)SCI,(2)疾病临床表现时AQP4(aquaporin 4)-IgG或MOG(髓鞘少突胶质细胞糖蛋白)-IgG相关的骨髓炎,或(3)特发性横纹肌炎。
并测量这些患者血清神经丝轻链水平(pg/mL)。并对于每位患者,最大的脊髓病变面积(mm2)进行量化。

 

结果显示:纳入SCI患者48例,20例(明确,11例;可能,6例;可能,3例);急性脊髓炎28例(AQP4-IgG相关,17例;MOG-IgG相关,5例;特发性横纹肌炎,6例)。髓鞘炎晚期扩大残疾状态量表评分的中位数(范围)分别为7.75(2-8.5)和5.5(2-8)。

相对于AQP4-IgG相关骨髓炎、MOG-IgG相关骨髓炎、特发性横纹肌炎患者,SCI患者血清神经丝轻链水平血清神经丝轻链水平显著升高(P=0.01)。

NAR对SCI与急性骨髓炎的鉴别准确率最高,数值≥0.35pg/(mL-mm2)可产生86%的特异性和95%的敏感性(AUC=0.93)。调整年龄、性别、取样前的免疫治疗、骨髓病症状发生到取样的天数后,NAR仍与SCI独立相关(P=0.0007)


这个研究的重要意义在于,发现了神经丝轻链/面积比值-NAR是区分自发性脊髓梗死和急性脊髓炎的良好临床生物标记物。

原文出处:

Sechi, E., Mariotto, S., McKeon, A., Krecke, K. N., Pittock, S. J., Ferrari, S., ... & Zalewski, N. L. (2020). Serum Neurofilament to Magnetic Resonance Imaging Lesion Area Ratio Differentiates Spinal Cord Infarction From Acute Myelitis. _Stroke_, STROKEAHA-120.

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    2021-09-12 xlysu
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    2021-02-17 sodoo
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    2021-02-16 ms9000000937213742

    学习

    0

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    2021-02-16 ms1000000686260508

    学习了#脊髓#

    0

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