血清胶质纤维酸性蛋白、神经丝轻链水平与阿尔茨海默病病情严重程度及预后的相关性

Correlation of the serum levels of glial fibrillary acidic protein and neurofilament light chain with the severity and prognosis of Alzheimer disease

摘要:

目的 探究血清胶质纤维酸性蛋白（GFAP）、神经丝轻链（NfL）水平与阿尔茨海默病（AD）患者病情严重程度的相关性及其对预后的预测价值。方法 纳入2024年7月至2025年2月于郑州大学第五附属医院神经内科就诊的155例AD患者作为研究对象。按临床痴呆量表（CDR）将患者分为轻度组（52例，CDR 1分）、中度组（61例，CDR 2分）、重度组（42例，CDR 3分）。随访1年，根据是否发生预后不良事件将患者分为预后不良组（67例）及预后良好组（88例）。采用广义相加模型（GAM）分析病情严重程度与血清GFAP、NfL水平的相关性；采用多因素Logistic回归分析评估AD预后的影响因素；采用受试者操作特征曲线（ROC）分析血清GFAP、NfL对不同程度AD患者预后不良的预测效能。结果 与轻度组比较，中度组和重度组血清GFAP、NfL水平更高（P<0.05）。GAM结果显示，血清GFAP、NfL水平随病情严重程度增加而增加。预后不良组血清GFAP、NfL水平均高于预后良好组（P<0.05）。多因素Logistic回归分析显示，血清GFAP、NfL是预后不良的影响因素。重度组中，高水平血清GFAP、NfL患者预后不良的比例更高。血清GFAP、NfL水平的升高与患者AD病情严重程度和预后不良呈正相关。血清GFAP、NfL联合预测重度AD患者预后不良的曲线下面积（AUC）为0.915，灵敏度和特异度分别为0.793、0.923。结论 AD患者血清GFAP、NfL水平随着病情严重程度增加而升高，且与预后不良相关。

Abstract:

To investigate the correlation of the serum levels of glial fibrillary acidic protein （GFAP） and neurofilament light chain （NfL） with disease severity in patients with Alzheimer disease （AD）， as well as their value in predicting prognosis.Methods A total of 155 AD patients who attended the Department of Neurology， The Fifth Affiliated Hospital of Zhengzhou University， from July 2024 to February 2025 were enrolled， and according to the Clinical Dementia Rating （CDR） scale， they were divided into mild group （52 patients， CDR 1）， moderate group （61 patients， CDR 2）， and severe group （42 patients， CDR 3）. The patients were followed up for 1 year， and according to the prognosis， the patients were divided into poor prognosis group with 67 patients and good prognosis group with 88 patients. The generalized additive model （GAM） was used to investigate the correlation between disease severity and the levels of GFAP and NfL； the multivariate logistic regression analysis was used to identify the influencing factors for prognosis； the receiver operating characteristic （ROC） curve was plotted to assess the efficacy of GFAP and NfL in predicting poor prognosis in AD patients with different disease severities.Results Compared with the mild group， the moderate group and the severe group had significantly higher serum levels of GFAP and NfL （P<0.05）. The GAM analysis showed that the serum levels of GFAP and NfL increased with the increase in disease severity. The poor prognosis group had significantly higher serum levels of GFAP and NfL than the good prognosis group （P<0.05）. The multivariate logistic regression analysis showed that serum GFAP and NfL were influencing factors for poor prognosis （P<0.05）. In the severe group， there was a relatively high proportion of patients with poor prognosis among the patients with high serum levels of GFAP and NfL. Increases in the serum levels of GFAP and NfL were positively correlated with disease severity and poor prognosis in AD patients. The combination of serum GFAP and NfL had an area under the ROC curve of 0.915 in predicting poor prognosis in AD patients， with a sensitivity of 0.793 and a specificity of 0.923.Conclusions The serum levels of GFAP and NfL increase with increase in disease severity in AD patients and are associated with poor prognosis.