Giovanni Siconolfi, Francesca Vitali, Maria Ausilia Sciarrone, Valeria Guglielmino, Guido Primiano, Marco Luigetti
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In addition, we included data from our own cohort of patients with GBS-whose NfL levels were measured at disease onset-and from healthy controls. The primary outcome was the difference in NfL levels-both in serum and cerebrospinal fluid (CSF)-between patients with GBS and controls. Secondary outcomes included the correlations between acute-phase NfL levels, clinical severity at admission as measured by the Guillain-Barré Disability Scale (GBDS) or the Hughes Functional Scale (HFS), and long-term outcomes such as the inability to walk or run 1 year after disease onset.</p><p><strong>Results: </strong>In this meta-analysis of nine studies, which also included data from our cohort, serum NfL levels were significantly higher in patients with GBS compared with controls (mean difference 143.17 pg/mL, 95% CI 67.7-218.6; p < 0.01; I<sup>2</sup> = 83%). In contrast, the difference in CSF NfL levels only approached statistical significance (mean difference 2091.1 pg/mL, 95% CI 171.2-4353.4; p = 0.07, I<sup>2</sup> = 92.1%). These findings were corroborated in our cohort, where median serum NfL concentrations were markedly higher in patients with GBS compared to controls (97 pg/mL, IQR 79-194 vs. 15 pg/mL, IQR 13-20; p < 0.05, Wilcoxon rank-sum test). Serum NfL levels were higher in patients with the acute motor axonal neuropathy (AMAN) compared to those with acute inflammatory demyelinating polyneuropathy (AIDP) (MD 531.9 pg/mL, 95% CI 32.8-1031.01; I<sup>2</sup> = 81.1%; p = 0.04). 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引用次数: 0
摘要
格林-巴罗综合征（GBS）是一种急性免疫介导的周围神经系统疾病，以神经系统症状的快速发作为特征。尽管在了解病因和改善临床管理方面取得了进展，但目前还没有经过验证的生物标志物可用于预测急性期的疾病严重程度或治疗反应。本荟萃分析旨在评估血清神经丝轻链（NfL）作为GBS急性疾病活动性和预后结果的生物标志物的作用。方法：使用PubMed、Scopus和Cochrane图书馆数据库进行系统回顾和荟萃分析，以确定评估GBS患者NfL水平的研究。此外，我们纳入了来自我们自己的gbs患者队列的数据-在疾病发病时测量其NfL水平-以及来自健康对照的数据。主要结果是GBS患者和对照组之间血清和脑脊液（CSF）中NfL水平的差异。次要结局包括急性期NfL水平、入院时临床严重程度（由格林-巴罗伊残疾量表（GBDS）或休斯功能量表（HFS）测量）和长期结局（如疾病发病1年后无法行走或跑步）之间的相关性。结果：在这项包含9项研究的荟萃分析中，GBS患者的血清NfL水平显著高于对照组（平均差异143.17 pg/mL, 95% CI 67.7-218.6; p = 83%）。相比之下，脑脊液NfL水平差异仅接近统计学意义（平均差异2091.1 pg/mL, 95% CI 171.2 ~ 4353.4; p = 0.07, I2 = 92.1%）。这些发现在我们的队列中得到了证实，GBS患者血清中位NfL浓度明显高于对照组（97 pg/mL, IQR 79-194 vs. 15 pg/mL, IQR 13-20; p = 81.1%; p = 0.04）。结论：血清NfL是GBS早期诊断和预后的一种有前景的生物标志物，可能支持住院时的风险分层。
Neurofilament Light Chain Levels as Diagnostic and Prognostic Biomarkers in Guillain-Barré Syndrome: An Updated Systematic Review and Meta-Analysis.
Introduction: Guillain-Barré syndrome (GBS) is an acute immune-mediated disorder of the peripheral nervous system, marked by rapid onset of neurological symptoms. Despite progress in understanding the etiology and improving clinical management, no validated biomarkers are currently available to predict disease severity or treatment response during the acute phase. This meta-analysis aims to evaluate the role of serum neurofilament light chain (NfL) as a biomarker of acute disease activity and prognostic outcomes in GBS.
Methods: A systematic review and meta-analysis was conducted using PubMed, Scopus, and Cochrane Library databases to identify studies assessing NfL levels in patients with GBS. In addition, we included data from our own cohort of patients with GBS-whose NfL levels were measured at disease onset-and from healthy controls. The primary outcome was the difference in NfL levels-both in serum and cerebrospinal fluid (CSF)-between patients with GBS and controls. Secondary outcomes included the correlations between acute-phase NfL levels, clinical severity at admission as measured by the Guillain-Barré Disability Scale (GBDS) or the Hughes Functional Scale (HFS), and long-term outcomes such as the inability to walk or run 1 year after disease onset.
Results: In this meta-analysis of nine studies, which also included data from our cohort, serum NfL levels were significantly higher in patients with GBS compared with controls (mean difference 143.17 pg/mL, 95% CI 67.7-218.6; p < 0.01; I2 = 83%). In contrast, the difference in CSF NfL levels only approached statistical significance (mean difference 2091.1 pg/mL, 95% CI 171.2-4353.4; p = 0.07, I2 = 92.1%). These findings were corroborated in our cohort, where median serum NfL concentrations were markedly higher in patients with GBS compared to controls (97 pg/mL, IQR 79-194 vs. 15 pg/mL, IQR 13-20; p < 0.05, Wilcoxon rank-sum test). Serum NfL levels were higher in patients with the acute motor axonal neuropathy (AMAN) compared to those with acute inflammatory demyelinating polyneuropathy (AIDP) (MD 531.9 pg/mL, 95% CI 32.8-1031.01; I2 = 81.1%; p = 0.04). Moreover, NfL levels positively correlated with disease severity at admission (r = 0.38; p < 0.001) and poor long-term outcomes (OR 3.74, 95% CI 1.05-13.37; p < 0.001).
Conclusion: Serum NfL is a promising biomarker for early diagnosis and prognosis in GBS and may support risk stratification at hospital admission.
期刊介绍：
Aims and Scope
Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice.
Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed.
The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Neurology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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Upon submission, manuscripts are assessed by the editorial team to ensure they fit within the aims and scope of the journal and are also checked for plagiarism. All suitable submissions are then subject to a comprehensive single-blind peer review. Reviewers are selected based on their relevant expertise and publication history in the subject area. The journal has an extensive pool of editorial and advisory board members who have been selected to assist with peer review based on the afore-mentioned criteria.
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