神经退行性疾病患者血清神经丝轻链蛋白水平变化的Meta分析  

Changes in serum neurofilament light chain protein levels in patients with neurodegenerative diseases:a Meta-analysis

作　　者：付旭东 李茂庚 程波 冯宇梁 张树山[1] FU Xudong;LI Maogeng;CHENG Bo;FENG Yuliang;ZHANG Shushan(Department of Neurology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637500,Sichuan Province,China)

机构地区：[1]川北医学院附属医院神经内科,四川南充637500

出　　处：《医学新知》2024年第4期424-437,共14页New Medicine

摘　　要：目的系统评价血清神经丝轻链蛋白(neurofilament light chain protein,NfL)在神经退行性疾病及不同认知损害程度患者中的变化。方法计算机检索PubMed、Embase、Web of Science、中国知网、万方和中国生物医学文献库数据库,纳入阿尔茨海默病(Alzheimer's disease,AD)、帕金森病(Parkinson's disease,PD)、多系统萎缩(multiple system atrophy,MSA)、进行性核上性麻痹(progressive supranuclear palsy,PSP)患者和健康对照均有血清NfL值的队列或病例对照研究,检索时间为建库至2023年4月30日。使用纽卡斯尔-渥太华量表评价纳入研究的风险偏倚,采用RevMan 5.4软件统计分析暴露组与非暴露组间的血清NfL值差异,合并效应量采用标准均数差(standard mean difference,SMD)及95%可信区间(confidence interval,CI)表示。结果纳入43篇文献,共提取了62项对比研究。对PD、AD、MSA、PSP与各自健康对照组分组比较,四组分别纳入9项、24项、9项、8项研究。PD组[SMD=0.27,95%CI(0.17,0.36)]、AD组[SMD=0.97,95%CI(0.70,1.23)]、MSA组[SMD=1.51,95%CI(0.97,2.05)]、PSP组[SMD=1.54,95%CI(1.14,1.93)]血清NfL水平均高于各自健康对照组。对帕金森病认知正常(PD normal cognitive,PD-NC)与帕金森病痴呆(PD with dementia,PD-D)、阿尔茨海默病轻度认知减退(AD mild cognitive impairment,AD-MCI)与阿尔茨海默病痴呆(AD with dementia,AD-D)分组比较,两对比组分别纳入3项和9项研究,PD-D患者血清NfL水平高于PD-NC患者[SMD=0.92,95%CI(0.63,1.20)],AD-D患者血清NfL水平高于AD-MCI患者[SMD=0.61,95%CI(0.49,0.72)]。结论PD、AD、MSA、PSP患者血清NfL水平较健康人群升高,且认知损害程度越大,血清NfL水平越高,血清NfL可能是神经退行性疾病潜在的外周生物标志物,能够进一步反映认知水平的下降。Objective To systematic evaluate the change of serum neurofilament light chain protein(NfL)level in patients with different neurodegenerative disease and different degrees of cognitive impairment.Methods A comprehensive search of literatures was conducted in the PubMed,Embase,Web of Science,CNKI,Wanfang and CBM from inception to April 30,2023.Literatures with serum NfL levels in patients with Alzheimer's disease(AD),Parkinson's disease(PD),multiple system atrophy(MSA),progressive supranuclear palsy(PSP)and healthy controls were included in the cohort or case-control studies.The Newcastle-Ottawa Scale was used to evaluate the quality of the included studies.RevMan 5.4 software was used to analyze the change of serum NfL between exposure group and non-exposure group.The effect size was expressed by standard mean difference(SMD)and 95%confidence interval(CI).Results 62 comparative studies extracted from a total of 43 literatures were included.Comparing PD,AD,MSA,PSP with their respective healthy control groups,the four groups included 9,24,9,and 8 studies,respectively.The levels of serum NfL in the PD group[SMD=0.27,95%CI(0.17,0.36)],AD group[SMD=0.97,95%CI(0.70,1.23)],MSA group[SMD=1.51,95%CI(0.97,2.05)],and PSP group[SMD=1.5495%CI(1.14,1.93)]were higher than those in the healthy controls in their respective groups.Further comparison was conducted between PD normal cognitive(PD-NC)and PD with dementia(PD-D),AD mild cognitive impairment(AD-MCI)and AD with dementia(AD-D)groups.3 and 9 studies were included in the two comparison groups,respectively.The serum NfL levels of PD-D patients were higher than those of PD-NC patients[SMD=0.92,95%CI(0.63,1.20)],and the serum NfL levels of AD-D patients were higher than those of AD-MCI patients[SMD=0.61,95%CI(0.49,0.72)].Conclusion The serum NfL levels in patients with PD,AD,MSA,and PSP are higher than those in healthy individuals,and the greater the degree of cognitive impairment,the higher the serum NfL levels.Serum NfL may be a potential peripheral biomarker reflecting neuro

关 键 词：生物标志物 神经丝轻链蛋白 神经退行性疾病 阿尔茨海默病 帕金森病 进行性核上性麻痹 多系统萎缩 系统评价 META分析 

分 类 号：R741[医药卫生—神经病学与精神病学]