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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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, Gröschel 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.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 2018, 51(9): 666-682.
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21.	门雪娇, 陈玮琪, 许玉园, 等. 穿支动脉粥样硬化病中国专家共识. 中国卒中杂志, 2021, 16(5): 508-514.
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24.	Khoshnam SE, Winlow W, Farzaneh M, et al. Pathogenic mechanisms following ischemic stroke. Neurol Sci, 2017, 38(7): 1167-1186.
25.	吴丹, 漆仲文, 张伟, 等. 脑缺血/再灌注损伤后线粒体结构与功能稳态失衡机制的研究进展. 中国医药导报, 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, 李芸, 肖露露, 等. 腔隙性脑梗死患者早期神经功能恶化相关因素及与脑白质病变的关联研究. 中华神经科杂志, 2014, 47(9): 633-637.
28.	陈英道, 张岐平, 李育英, 等. 急性缺血性脑卒中患者早期神经功能恶化的影响因素. 广西医学, 2020, 42(4): 401-405.
29.	石若南, 潘玉君. 急性缺血性脑卒中后早期神经功能恶化的危险因素分析. 卒中与神经疾病, 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.	孙美, 侯晓夏, 吕梦伟, 等. 急性缺血性卒中患者早期神经功能恶化的预测因素. 国际脑血管病杂志, 2018, 26(9): 654-659.

1. 孙海欣, 王文志. 中国 60 万人群脑血管病流行病学抽样调查报告. 中国现代神经疾病杂志, 2018, 18(2): 83-88.
2. 王拥军, 李子孝, 谷鸿秋, 等. 中国卒中报告 2019(中文版)(1). 中国卒中杂志, 2020, 15(10): 1037-1043.
3. 周锦涛, 易兴阳, 林静, 等. 环氧二十碳三烯酸受 EPHX2 基因调控与急性缺血性小卒中后早期神经功能恶化发生相关. 中华神经科杂志, 2021, 54(5): 441-448.
4. 钱新宇, 杨思远, Bilal M, 等. 溶栓后中性粒细胞升高与缺血性脑卒中早期神经功能恶化相关性研究. 华西医学, 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. 肖静怡. 急性缺血性脑卒中早期神经功能恶化预测模型的构建与验证. 广州: 广州医科大学, 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, Jäkälä 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, Gröschel 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. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 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. 门雪娇, 陈玮琪, 许玉园, 等. 穿支动脉粥样硬化病中国专家共识. 中国卒中杂志, 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. 吴丹, 漆仲文, 张伟, 等. 脑缺血/再灌注损伤后线粒体结构与功能稳态失衡机制的研究进展. 中国医药导报, 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, 李芸, 肖露露, 等. 腔隙性脑梗死患者早期神经功能恶化相关因素及与脑白质病变的关联研究. 中华神经科杂志, 2014, 47(9): 633-637.
28. 陈英道, 张岐平, 李育英, 等. 急性缺血性脑卒中患者早期神经功能恶化的影响因素. 广西医学, 2020, 42(4): 401-405.
29. 石若南, 潘玉君. 急性缺血性脑卒中后早期神经功能恶化的危险因素分析. 卒中与神经疾病, 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. 孙美, 侯晓夏, 吕梦伟, 等. 急性缺血性卒中患者早期神经功能恶化的预测因素. 国际脑血管病杂志, 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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