血清神经丝轻链和胶质纤维酸性蛋白水平预测急性脑梗死患者神经功能恢复和预后的价值

张建强; 沈瑞乐

doi:10.16766/j.cnki.issn.1674-4152.004288

血清神经丝轻链和胶质纤维酸性蛋白水平预测急性脑梗死患者神经功能恢复和预后的价值

doi: 10.16766/j.cnki.issn.1674-4152.004288

张建强,
沈瑞乐^,

河南科技大学第一附属医院神经内科，河南洛阳 471003

基金项目:

河南省医学科技攻关计划项目 SBGJ202302095

详细信息

通讯作者:
沈瑞乐，E-mail：shenruile0379@126.com

中图分类号: R743.3 R730.7
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出版历程
- 收稿日期: 2025-08-11
- 网络出版日期: 2026-03-13

Value of serum neurofilament light chain and glial fibrillary acidic protein levels in predicting neurological recovery and prognosis in patients with acute cerebral infarction

ZHANG Jianqiang,
SHEN Ruile^,

Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, China

摘要

摘要: 目的探讨血清神经丝轻链(NfL)和胶质纤维酸性蛋白(GFAP)水平对急性脑梗死(AIS)患者神经损伤和修复的影响，为个体化治疗提供依据。方法纳入2020年1月—2022年12月河南科技大学第一附属医院收治的129例AIS患者，根据出院后3个月改良Rankin(mRS)评分将患者分为预后良好组(mRS评分≤2分，83例)和预后不良组(mRS评分>2分，46例)。分析2组患者临床特征和NfL、GFAP水平的差异，评估两者的预后预测价值，分析AIS患者神经功能不良预后的危险因素。结果与预后良好组比较，预后不良组NfL(15.2±6.3 vs. 22.8±8.5，t=5.777，P＜0.001)和GFAP[0.85(0.62, 1.18) vs. 1.12(0.79, 1.45)，U=1 254.000，P=0.003]水平升高，两者与患者美国国立卫生研究院卒中量表(NIHSS)评分和梗死体积呈正相关关系。血清NfL(OR=1.861，95% CI: 1.076~3.220，P=0.024)和GFAP(OR=2.979，95% CI: 1.428~6.218，P=0.004)升高是AIS患者预后不良的独立影响因素。两者联合检测可以提高预测AIS患者神经功能预后的准确性(AUC=0.809)。结论联合检测NfL和GFAP水平有助于早期识别神经功能不良的AIS患者，指导个体化治疗方案的制定。
- 急性脑梗死 /
- 神经丝轻链 /
- 胶质纤维酸性蛋白 /
- 神经功能恢复 /
- 预后 /
- 生物标志物
Abstract: Objective To investigate the impact of serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) levels on neurological injury and recovery in acute ischemic stroke (AIS) patients, providing evidence for personalized treatment. Methods A total of 129 AIS patients admitted to our hospital from January 2020 to December 2022 were included. According to the modified Rankin scale (mRS) score at 3 months post-discharge, patients were divided into a good prognosis group (mRS≤2, 83 cases) and a poor prognosis group (mRS>2, 46 cases). The clinical characteristics and serum levels of NfL and GFAP were compared between the two groups. The prognostic predictive value of these biomarkers and risk factors for poor neurological outcomes in AIS patients were analyzed. Results Compared with the good prognosis group, the poor prognosis group had significantly higher levels of NfL (15.2±6.3 vs. 22.8±8.5, t=5.777, P < 0.001) and GFAP [0.85 (0.62, 1.18) vs. 1.12 (0.79, 1.45), U=1 254.000, P=0.003], both of which were positively correlated with NIHSS scores and infarct volume. Multivariate regression analysis showed that elevated NfL (OR=1.861, 95% CI: 1.076-3.220, P=0.024) and GFAP (OR=2.979, 95% CI: 1.428-6.218, P=0.004) were independent influencing factors for poor prognosis in AIS patients. The combined detection of NfL and GFAP demonstrated higher predictive accuracy for neurological outcomes (AUC=0.809) compared to single biomarker detection. Conclusion Combined detection of serum NfL and GFAP levels is useful for early identification of AIS patients at risk of poor neurological outcomes and provides evidence for developing personalized treatment strategies.
- Acute ischemic stroke /
- Neurofilament light chain /
- Glial fibrillary acidic protein /
- Neurological functional recovery /
- Prognosis /
- Biomarker

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图 1 血清NfL和GFAP对脑梗死患者神经功能不良预后的ROC曲线

Figure 1. ROC curves of serum NfL and GFAP for poor prognosis of neurological function in patients with cerebral infarction

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表 1 预后良好组和预后不良组临床特征比较

Table 1. Comparison of clinical characteristics between good and poor prognosis groups

临床特征	预后良好组 (n=83)	预后不良组 (n=46)	统计量	P值
年龄(x±s，岁)	63.5±10.8	65.2±12.1	0.820^a	0.414
性别(男性/女性，例)	51/32	27/19	0.062^b	0.803
BMI(x±s)	24.3±3.1	24.8±3.5	0.838^a	0.404
吸烟史[例(%)]	32(38.6)	18(39.1)	0.002^b	0.964
饮酒史[例(%)]	25(30.1)	13(28.3)	0.031^b	0.860
高血压病史[例(%)]	58(69.9)	34(73.9)	0.213^b	0.644
糖尿病史[例(%)]	35(42.2)	19(41.3)	0.008^b	0.928
房颤史[例(%)]	12(14.5)	7(15.2)	0.016^b	0.899
梗死部位(前循环/后循环，例)	61/22	33/13	0.032^b	0.858
梗死类型[例(%)]			0.256^b	0.613
大动脉粥样硬化	36(43.4)	19(41.3)
心源性栓塞	27(32.6)	11(23.9)
小动脉闭塞	10(12.0)	8(17.4)
其他病因	8(9.6)	5(10.9)
原因不明型	2(2.4)	3(6.5)
入院时NIHSS评分(x±s，分)	7.2±3.5	10.5±4.1	4.821^a	＜0.001
梗死体积(x±s，mL)	22(13, 38)	36(21, 53)	812.500^c	0.002
治疗方案[例(%)]			0.618^b	0.358
药物治疗	61(73.5)	30(65.2)
介入治疗	22(26.5)	16(34.8)
发病到入院时间(x±s，h)	4.8±1.3	5.2±1.1	1.110^a	0.269
住院期间并发症[例(%)]	15(18.1)	18(39.1)	5.832^b	0.016
注：^a为t值，^b为χ²值，^c为U值。

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表 2 预后良好组和预后不良组AIS患者血清NfL、GFAP水平比较

Table 2. Comparison of serum NfL and GFAP levels between good and poor prognosis groups of AIS patients

组别	例数	NfL (x±s，pg/mL)	GFAP [M(P₂₅, P₇₅)，ng/mL]
预后良好组	83	15.2±6.3	0.85(0.62, 1.18)
预后不良组	46	22.8±8.5	1.12(0.79, 1.45)
统计量		5.777^a	1 254.000^b
P值		＜0.001	0.003
注：^a为t值，^b为U值。

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表 3 急性脑梗死患者神经功能恢复不良影响因素的logistic回归分析

Table 3. Logistic regression analysis of factors influencing poor neurological function recovery in patients with acute cerebral infarction

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.712	0.435	2.680	0.101	2.038	0.892~4.659
性别	0.509	0.415	1.503	0.220	1.663	0.782~3.537
入院时NIHSS评分	1.278	0.632	4.092	0.043	3.590	1.027~12.541
梗死体积	1.045	0.366	8.163	0.004	2.844	1.415~5.709
血清NfL	0.621	0.275	5.095	0.024	1.861	1.076~3.220
血清GFAP	1.092	0.389	7.893	0.004	2.979	1.428~6.218
发病至入院时间	0.302	0.467	0.418	0.518	1.352	0.491~3.723
住院期间并发症	1.143	0.423	7.303	0.007	3.137	1.376~7.155
注：变量赋值如下，入院时NIHSS评分、梗死体积、血清NfL、血清GFAP发病至入院时间均为连续型变量，以实际值赋；住院期间并发症(有=1，无=0)。

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表 4 血清NfL和GFAP对脑梗死患者神经功能不良预后的诊断效能

Table 4. Diagnostic efficacy of serum NfL and GFAP for poor neurological outcome in patients with cerebral infarction

项目	AUC(95% CI)	灵敏度 (%)	特异度 (%)	最佳临界值	约登指数	Z值	P值
NfL	0.736(0.651~0.810)	67.39	68.67	18.4 pg/mL	0.361	4.957	＜0.001
GFAP	0.749(0.665~0.821)	56.52	91.57	1.17 ng/mL	0.481	5.014	＜0.001
联合检测	0.809(0.731~0.873)	74.74	85.54		0.573	6.984	＜0.001

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