活动性神经精神系统性红斑狼疮神经元和神经胶质损伤的血液生物标志物。

IF 1.9 4区 医学 Q3 RHEUMATOLOGY Lupus Pub Date : 2024-09-01 Epub Date: 2024-08-16 DOI:10.1177/09612033241272961
Ryan Kammeyer, Kimberly Chapman, Anna Furniss, Elena Hsieh, Robert Fuhlbrigge, Ekemini A Ogbu, Susan Boackle, JoAnn Zell, Kavita V Nair, Tyler L Borko, Jennifer C Cooper, Jeffrey L Bennett, Amanda L Piquet
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引用次数: 0

摘要

背景:神经精神系统性红斑狼疮(NPSLE)是系统性红斑狼疮的一种难以理解的异质性表现。常见的主要非系统性红斑狼疮综合征包括中风、癫痫发作、脊髓炎和无菌性脑膜炎。我们需要易于获得的生物标志物来协助早期诊断并改善非系统性红斑狼疮的预后。主要综合征的一个常见最终结果是神经元或神经胶质损伤。血液中的神经丝蛋白(NfL)和神经胶质纤维酸性蛋白(GFAP)已被用作监测其他神经退行性疾病和神经炎症性疾病的疾病活动和/或严重程度的标志物,但它们尚未在活动性重症非系统性红斑狼疮中进行评估:这是一项病例对照研究。我们招募了年龄在 12-60 岁的活动性重型非系统性红斑狼疮患者、无活动性重型非系统性红斑狼疮的系统性红斑狼疮患者以及健康对照组。活动性非系统性红斑狼疮被定义为结果:研究对象包括13名活动性重度非系统性红斑狼疮患者、13名年龄/性别/肾功能匹配的非活动性重度非系统性红斑狼疮对照组患者和13名年龄/性别匹配的健康对照组患者(平均年龄分别为26.8岁、27.3岁和26.6岁)。每组中92%为女性。主要综合征包括中风(5 例)、自主神经紊乱(3 例)、脱髓鞘疾病(2 例)、无菌性脑膜炎(2 例)、感觉运动性多发性神经病(2 例)、颅神经病(1 例)、癫痫发作(1 例)和脊髓病(2 例)。健康对照组的血液 NfL 和 GFAP 平均值(标准偏差)分别为 3.6 pg/ml (2.0) 和 50.4 pg/ml (15.0)。与健康对照组相比,无活动性主要非系统性红斑狼疮的系统性红斑狼疮患者的平均血液NfL和GFAP水平分别高出1.3 pg/ml(p = .42)和1.2 pg/ml(p = .53)。与无活动性严重非系统性红斑狼疮的系统性红斑狼疮患者相比,活动性严重非系统性红斑狼疮患者的血液NfL平均高17.9 pg/ml(95% CI:9.2,34.5;p < .001),血液GFAP平均高3.2 pg/ml(95% CI:1.9,5.5;p < .001)。在多个时间点采样的6名患者中,免疫疗法后血液中的NfL和GFAP均有所下降:结论:与疾病匹配的对照组相比,活动性主要非系统性红斑狼疮系统性红斑狼疮患者血液中的NfL和GFAP水平升高,免疫疗法开始后可能会降低。需要进行更大规模的纵向研究,以确定它们在临床环境中的效用。
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Blood-based biomarkers of neuronal and glial injury in active major neuropsychiatric systemic lupus erythematosus.

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a poorly understood and heterogeneous manifestation of SLE. Common major NPSLE syndromes include strokes, seizures, myelitis, and aseptic meningitis. Easily obtainable biomarkers are needed to assist in early diagnosis and improve outcomes for NPSLE. A frequent end-result of major syndromes is neuronal or glial injury. Blood-based neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) have been utilized as markers for monitoring disease activity and/or severity in other neurodegenerative and neuroinflammatory diseases; however, they have not been evaluated in active major NPSLE.

Methods: This was a case-control study. We enrolled patients aged 12-60 years with active major NPSLE, SLE without active major NPSLE, and healthy controls. Active NPSLE was defined as being <6 months from last new or worsening neuropsychiatric symptom. Demographics, clinical data, and serum or plasma biosamples were collected.

Results: Thirteen patients with active major NPSLE, 13 age/sex/kidney function matched SLE controls without active major NPSLE, and 13 age/sex matched healthy controls (mean ages 26.8, 27.3, 26.6 years) were included. 92% of each group were female. Major syndromes included stroke (5), autonomic disorder (3), demyelinating disease (2), aseptic meningitis (2), sensorimotor polyneuropathy (2), cranial neuropathy (1), seizures (1), and myelopathy (2). Mean (standard deviation) blood NfL and GFAP were 3.6 pg/ml (2.0) and 50.4 pg/ml (15.0), respectively, for the healthy controls. Compared to healthy controls, SLE without active major NPSLE had mean blood NfL and GFAP levels 1.3 pg/ml (p = .42) and 1.2 pg/ml higher (p = .53), respectively. Blood NfL was on average 17.9 pg/ml higher (95% CI: 9.2, 34.5; p < .001) and blood GFAP was on average 3.2 pg/ml higher (95% CI: 1.9, 5.5; p < .001) for cases of active major NPSLE compared to SLE without active major NPSLE. In a subset of 6 patients sampled at multiple time points, blood NfL and GFAP decreased after immunotherapy.

Conclusions: Blood NfL and GFAP levels are elevated in persons with SLE with active major NPSLE compared to disease matched controls and may lower after immunotherapy initiation. Larger and longitudinal studies are needed to ascertain their utility in a clinical setting.

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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
期刊最新文献
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