【独家精译】《Neurology》月度评述:纤维蛋白原——脑动脉夹层的新发现

本述评针对的研究文章摘要：

Abstract

Objective——To explore the value of plasma fibrillin-1 levels in patients with spontaneous cerebral artery dissection (sCeAD).

Methods——A single-center prospective cohort of 99 consecutive patients with sCeAD between February 2013 and December 2015 were age and sex matched with 115 patients with non-sCeAD ischemic stroke and 20 healthy participants undergoing routine physical examination. The plasma fibrillin-1 level was measured with ELISA and compared among the 3 groups. The associations of fibrillin-1 with site, acuity, and severity of dissection, as well as clinical and radiographic prognosis of patients, were analyzed.

Results——One hundred nine plasma samples from 99 patients with sCeAD, 115 from disease control patients, and 20 from healthy participants were collected. The plasma fibrillin-1 level of the dissection group (mean 85.56 ng/mL [95% confidence interval 81.53–89.59]) was higher than that of non-sCeAD ischemic stroke group (77.13 ng/mL [73.64–80.63], p = 0.015) or healthy controls (73.04 ng/mL [65.94–80.13], p = 0.029). Such differences were most prominent in the acute stage (97.64 ng/mL [91.64–103.64], 74.39 ng/mL [68.95–79.84], and 73.04 ng/mL [65.95–80.13], respectively). A cutoff value of 88.455 ng/mL was determined to differentiate acute dissection from nondissection stroke with a sensitivity of 0.778 and a specificity of 0.800. Higher fibrillin-1 level was detected in patients with more severe dissection radiographically (p< 0.001), while patients with lower fibrillin-1 concentration at baseline achieved better morphologic recovery on follow-up imaging tests (p = 0.003).

Conclusion——Plasma fibrillin-1 is a promising biomarker for aiding the diagnosis of acute sCeAD and may have potential value in lesion severity grading and radiographic prognosis prediction.

Classification of evidence

This study provides Class III evidence that patients with sCeAD have significantly higher levels of plasma fibrillin-1 than patients with ischemic stroke attributable to a cause other than sCeAD.