Multiple sclerosis (MS) is a heterogeneous disease. With several disease modifying treatments of different mechanisms of action in use now and in development, it is important to identify reliable biomarkers to identify those higher risk MS patients in whom stronger but riskier treatments might be used, as well as to identify those for whom safer treatments of lower efficacy would be sufficient. Here we review cerebrospinal fluid (CSF) and blood biomarkers that show promise for differentiating people with MS who are at risk for severe disease and disability from those with more benign disease. We reviewed published literature for studies reporting biomarkers with predictive value in MS. Most studies of MS CSF found the presence of oligoclonal bands (both IgG and IgM), high IgG index and high levels of kappa light chains to each be associated with worse prognosis. Neurofilament light chain (NfL) and two markers of glial activation, glial fibrillary acidic protein (GFAP) and YKL-40, were higher in CSF of people with subsequent clinical progression or imaging evidence for neurodegeneration. Few reports have been made yet on the prognostic significance of blood NfL, but in one early report baseline, serum NfL (sNfL) predicted subsequent brain volume loss.

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CSF 生物标志物能否预测未来 MS 疾病的活动性和严重程度？

多发性硬化症 (MS) 是一种异质性疾病。随着几种不同作用机制的疾病改善治疗正在使用和开发中，重要的是要确定可靠的生物标志物来识别那些可能使用更强但风险更高的治疗的高风险 MS 患者，以及确定那些对他们来说更安全的治疗方法。较低疗效的治疗就足够了。在这里，我们回顾了脑脊液 (CSF) 和血液生物标志物，这些生物标志物有望将有严重疾病和残疾风险的 MS 患者与良性疾病患者区分开来。我们回顾了已发表的文献，这些研究报告了对 MS 具有预测价值的生物标志物。大多数 MS CSF 研究发现存在寡克隆带（IgG 和 IgM），高 IgG 指数和高水平 kappa 轻链均与较差的预后相关。神经丝轻链 (NfL) 和两个神经胶质激活标志物，神经胶质纤维酸性蛋白 (GFAP) 和 YKL-40，在随后出现临床进展或神经变性影像学证据的人的脑脊液中较高。关于血液 NfL 的预后意义的报道很少，但在一份早期报告的基线中，血清 NfL (sNfL) 预测了随后的脑容量损失。