探索导致药物耐药性的途径,用于患有密码新发症耐火状态性的患者
Aurélie Hanin1,2, Clémence Marois3, Martin Guillemaud1
1Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Institut National de de la Santé et de Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Institut National de la Recherche en Informatique et en Automatique (INRIA), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital de la Pitié Salpêtrière, Paris, France.
在急性密码性新发 refractory status epilepticus (cNORSE) 中,存在先天性免疫激活,但会消失. 持续的神经纤维光链 (NfL) 升高表明正在进行的轴突损伤,而不是慢性炎症,导致cNORSE患者的不良结果.
科学领域:
- 神经科学是一个神经科学.
- 免疫学 免疫学 免疫学
- 发病学 (Epileptology) 是一个专业的学科.
背景情况:
- 密码性新发性耐火状态 (cNORSE) 与显著的长期残疾和有关.
- 根底的机制和cNORSE持续性免疫障碍的潜力仍然不清楚.
- 了解这些因素对于预测结果和经过cNORSE后慢性的管理至关重要.
研究的目的:
- 评估急性cNORSE中炎症和脑损伤生物标志物的预测价值.
- 为了确定免疫系统障碍是否持续到cNORSE后的慢性阶段.
- 为了确定与cNORSE后发育相关的生物标志物.
主要方法:
- 血清和脑脊液 (CSF) 样本从93名cNORSE患者在状态 (SE) 期间收集.
- 生物标志物水平 (细胞因子,神经纤维光链[NfL],神经元特异性酶) 被急性分析,并与慢性阶段结果 (解决后6-12个月) 相比较.
- 后cNORSE患者与叶 (TLE-HS) 和慢性免疫媒介脑炎患者进行了比较.
主要成果:
- 在急性cNORSE期间增加的先天性细胞因子和NfL与更差的功能结果相关.
- 血清NfL与细胞因子结合,改善了不良结果的预测 (AUC=.75).
- 康诺斯后与长期的SE和MRI异常有关,而不是急性生物标志物. 大多数急性细胞因子正常化,但在一些患者中观察到适应性免疫变化和持续升高的NfL,特别是那些患有cNORSE后的患者.
结论:
- 急性性包括显著的先天性免疫激活,在很大程度上可以解决,这表明它不是慢性的主要驱动因素.
- 持续升高的NfL表明正在进行的神经轴损伤,这可能会导致长期不良的功能结果.
- 建议整合炎症和神经轴损伤生物标志物,以改善cNORSE患者的风险分层和管理.
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