Correlation between neurofilament light chain level and early neurological deterioration after acute cerebral infarction_West China Medical Journal

Authors：

QING Ting ¹ ,  YI Xingyang ² , ZHU Yalan ³ , CHEN Hong ² , DUAN Yong ⁴ , LIU Shan ⁵ , LI Jie ² , ZHANG Ping ² , ZENG Tao ²

1. Department of Neurology, the Second People’s Hospital of Deyang, Deyang, Sichuan 618000, P. R. China;
2. Department of Neurology, Deyang People’s Hospital, Deyang, Sichuan 618000, P. R. China;
3. Department of Neurology, Guanghan People’s Hospital, Deyang, Sichuan 618300, P. R. China;
4. Department of Neurology, People’s Hospital of Zhongjiang County, Deyang, Sichuan 618100, P. R. China;
5. Department of Neurology, Deyang Jingyang Hospital of T.C.M, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

YI Xingyang, Email: yixingyang64@126.com

Keywords：

Acute cerebral infarction; neurofilament light chain; early neurological deterioration

DOI：

10.7507/1002-0179.202202012

Video：

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Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.

Citation： QING Ting, YI Xingyang, ZHU Yalan, CHEN Hong, DUAN Yong, LIU Shan, LI Jie, ZHANG Ping, ZENG Tao. Correlation between neurofilament light chain level and early neurological deterioration after acute cerebral infarction. West China Medical Journal, 2023, 38(3): 403-407. doi: 10.7507/1002-0179.202202012 Copy

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4.	錢新宇, 楊思遠, Bilal M, 等. 溶栓后中性粒細胞升高與缺血性腦卒中早期神經功能惡化相關性研究. 華西醫學, 2019, 34(6): 641-648.
5.	Yi X, Han Z, Zhou Q, et al. 20-hydroxyeicosatetraenoic acid as a predictor of neurological deterioration in acute minor ischemic stroke. Stroke, 2016, 47(12): 3045-3047.
6.	Liu P, Liu S, Feng N, et al. Association between neurological deterioration and outcomes in patients with stroke. Ann Transl Med, 2020, 8(1): 4.
7.	肖靜怡. 急性缺血性腦卒中早期神經功能惡化預測模型的構建與驗證. 廣州: 廣州醫科大學, 2021.
8.	Yuan A, Rao MV, Veeranna, et al. Neurofilaments and neurofilament proteins in health and disease. Cold Spring Harb Perspect Biol, 2017, 9(4): a018309.
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11.	De Marchis GM, Katan M, Barro C, et al. Serum neurofilament light chain in patients with acute cerebrovascular events. Eur J Neurol, 2018, 25(3): 562-568.
12.	Pedersen A, Stanne TM, Nilsson S, et al. Circulating neurofilament light in ischemic stroke: temporal profile and outcome prediction. J Neurol, 2019, 266(11): 2796-2806.
13.	Gendron TF, Badi MK, Heckman MG, et al. Plasma neurofilament light predicts mortality in patients with stroke. Sci Transl Med, 2020, 12(569): eaay1913.
14.	Liu D, Chen J, Wang X, et al. Serum neurofilament light chain as a predictive biomarker for ischemic stroke outcome: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis, 2020, 29(6): 104813.
15.	Khalil M, Teunissen CE, Otto M, et al. Neurofilaments as biomarkers in neurological disorders. Nat Rev Neurol, 2018, 14(10): 577-589.
16.	Uphaus T, Bittner S, Gr?schel S, et al. NfL (neurofilament light chain) levels as a predictive marker for long-term outcome after ischemic stroke. Stroke, 2019, 50(11): 3077-3084.
17.	Wang P, Fan J, Yuan L, et al. Serum neurofilament light predicts severity and prognosis in patients with ischemic stroke. Neurotox Res, 2020, 37(4): 987-995.
18.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2018. 中華神經科雜志, 2018, 51(9): 666-682.
19.	Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol, 2007, 57(2): 96-102.
20.	O’Connell GC, Alder ML, Smothers CG, et al. Diagnosis of ischemic stroke using circulating levels of brain-specific proteins measured via high-sensitivity digital ELISA. Brain Res, 2020, 1739: 146861.
21.	門雪嬌, 陳瑋琪, 許玉園, 等. 穿支動脈粥樣硬化病中國專家共識. 中國卒中雜志, 2021, 16(5): 508-514.
22.	Seners P, Baron JC. Revisiting ‘progressive stroke’: incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke. J Neurol, 2018, 265(1): 216-225.
23.	Nam KW, Kang MK, Jeong HY, et al. Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: early prognosis in single subcortical infarctions. Int J Stroke, 2021, 16(8): 944-952.
24.	Khoshnam SE, Winlow W, Farzaneh M, et al. Pathogenic mechanisms following ischemic stroke. Neurol Sci, 2017, 38(7): 1167-1186.
25.	吳丹, 漆仲文, 張偉, 等. 腦缺血/再灌注損傷后線粒體結構與功能穩態失衡機制的研究進展. 中國醫藥導報, 2021, 18(31): 42-45, 66.
26.	He Y, Yang Q, Liu H, et al. Effect of blood pressure on early neurological deterioration of acute ischemic stroke patients with intravenous rt-PA thrombolysis may be mediated through oxidative stress induced blood-brain barrier disruption and AQP4 upregulation. J Stroke Cerebrovasc Dis, 2020, 29(8): 104997.
27.	王昭君, 李蕓, 肖露露, 等. 腔隙性腦梗死患者早期神經功能惡化相關因素及與腦白質病變的關聯研究. 中華神經科雜志, 2014, 47(9): 633-637.
28.	陳英道, 張岐平, 李育英, 等. 急性缺血性腦卒中患者早期神經功能惡化的影響因素. 廣西醫學, 2020, 42(4): 401-405.
29.	石若南, 潘玉君. 急性缺血性腦卒中后早期神經功能惡化的危險因素分析. 卒中與神經疾病, 2019, 26(5): 603-606, 610.
30.	Girot JB, Richard S, Gariel F, et al. Predictors of unexplained early neurological deterioration after endovascular treatment for acute ischemic stroke. Stroke, 2020, 51(10): 2943-2950.
31.	孫美, 侯曉夏, 呂夢偉, 等. 急性缺血性卒中患者早期神經功能惡化的預測因素. 國際腦血管病雜志, 2018, 26(9): 654-659.

1. 孫海欣, 王文志. 中國 60 萬人群腦血管病流行病學抽樣調查報告. 中國現代神經疾病雜志, 2018, 18(2): 83-88.
2. 王擁軍, 李子孝, 谷鴻秋, 等. 中國卒中報告 2019(中文版)(1). 中國卒中雜志, 2020, 15(10): 1037-1043.
3. 周錦濤, 易興陽, 林靜, 等. 環氧二十碳三烯酸受 EPHX2 基因調控與急性缺血性小卒中后早期神經功能惡化發生相關. 中華神經科雜志, 2021, 54(5): 441-448.
4. 錢新宇, 楊思遠, Bilal M, 等. 溶栓后中性粒細胞升高與缺血性腦卒中早期神經功能惡化相關性研究. 華西醫學, 2019, 34(6): 641-648.
5. Yi X, Han Z, Zhou Q, et al. 20-hydroxyeicosatetraenoic acid as a predictor of neurological deterioration in acute minor ischemic stroke. Stroke, 2016, 47(12): 3045-3047.
6. Liu P, Liu S, Feng N, et al. Association between neurological deterioration and outcomes in patients with stroke. Ann Transl Med, 2020, 8(1): 4.
7. 肖靜怡. 急性缺血性腦卒中早期神經功能惡化預測模型的構建與驗證. 廣州: 廣州醫科大學, 2021.
8. Yuan A, Rao MV, Veeranna, et al. Neurofilaments and neurofilament proteins in health and disease. Cold Spring Harb Perspect Biol, 2017, 9(4): a018309.
9. Tiedt S, Duering M, Barro C, et al. Serum neurofilament light: a biomarker of neuroaxonal injury after ischemic stroke. Neurology, 2018, 91(14): e1338-e1347.
10. Onatsu J, Vanninen R, J?k?l? P, et al. Serum neurofilament light chain concentration correlates with infarct volume but not prognosis in acute ischemic stroke. J Stroke Cerebrovasc Dis, 2019, 28(8): 2242-2249.
11. De Marchis GM, Katan M, Barro C, et al. Serum neurofilament light chain in patients with acute cerebrovascular events. Eur J Neurol, 2018, 25(3): 562-568.
12. Pedersen A, Stanne TM, Nilsson S, et al. Circulating neurofilament light in ischemic stroke: temporal profile and outcome prediction. J Neurol, 2019, 266(11): 2796-2806.
13. Gendron TF, Badi MK, Heckman MG, et al. Plasma neurofilament light predicts mortality in patients with stroke. Sci Transl Med, 2020, 12(569): eaay1913.
14. Liu D, Chen J, Wang X, et al. Serum neurofilament light chain as a predictive biomarker for ischemic stroke outcome: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis, 2020, 29(6): 104813.
15. Khalil M, Teunissen CE, Otto M, et al. Neurofilaments as biomarkers in neurological disorders. Nat Rev Neurol, 2018, 14(10): 577-589.
16. Uphaus T, Bittner S, Gr?schel S, et al. NfL (neurofilament light chain) levels as a predictive marker for long-term outcome after ischemic stroke. Stroke, 2019, 50(11): 3077-3084.
17. Wang P, Fan J, Yuan L, et al. Serum neurofilament light predicts severity and prognosis in patients with ischemic stroke. Neurotox Res, 2020, 37(4): 987-995.
18. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2018. 中華神經科雜志, 2018, 51(9): 666-682.
19. Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol, 2007, 57(2): 96-102.
20. O’Connell GC, Alder ML, Smothers CG, et al. Diagnosis of ischemic stroke using circulating levels of brain-specific proteins measured via high-sensitivity digital ELISA. Brain Res, 2020, 1739: 146861.
21. 門雪嬌, 陳瑋琪, 許玉園, 等. 穿支動脈粥樣硬化病中國專家共識. 中國卒中雜志, 2021, 16(5): 508-514.
22. Seners P, Baron JC. Revisiting ‘progressive stroke’: incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke. J Neurol, 2018, 265(1): 216-225.
23. Nam KW, Kang MK, Jeong HY, et al. Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: early prognosis in single subcortical infarctions. Int J Stroke, 2021, 16(8): 944-952.
24. Khoshnam SE, Winlow W, Farzaneh M, et al. Pathogenic mechanisms following ischemic stroke. Neurol Sci, 2017, 38(7): 1167-1186.
25. 吳丹, 漆仲文, 張偉, 等. 腦缺血/再灌注損傷后線粒體結構與功能穩態失衡機制的研究進展. 中國醫藥導報, 2021, 18(31): 42-45, 66.
26. He Y, Yang Q, Liu H, et al. Effect of blood pressure on early neurological deterioration of acute ischemic stroke patients with intravenous rt-PA thrombolysis may be mediated through oxidative stress induced blood-brain barrier disruption and AQP4 upregulation. J Stroke Cerebrovasc Dis, 2020, 29(8): 104997.
27. 王昭君, 李蕓, 肖露露, 等. 腔隙性腦梗死患者早期神經功能惡化相關因素及與腦白質病變的關聯研究. 中華神經科雜志, 2014, 47(9): 633-637.
28. 陳英道, 張岐平, 李育英, 等. 急性缺血性腦卒中患者早期神經功能惡化的影響因素. 廣西醫學, 2020, 42(4): 401-405.
29. 石若南, 潘玉君. 急性缺血性腦卒中后早期神經功能惡化的危險因素分析. 卒中與神經疾病, 2019, 26(5): 603-606, 610.
30. Girot JB, Richard S, Gariel F, et al. Predictors of unexplained early neurological deterioration after endovascular treatment for acute ischemic stroke. Stroke, 2020, 51(10): 2943-2950.
31. 孫美, 侯曉夏, 呂夢偉, 等. 急性缺血性卒中患者早期神經功能惡化的預測因素. 國際腦血管病雜志, 2018, 26(9): 654-659.

West China Medical Journal

Correlation between neurofilament light chain level and early neurological deterioration after acute cerebral infarction

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