PDF(Pubmed)
Abstract：
OBJECTIVE: Despite the growing evidence of the clinical utility of blood-brain biomarkers in adults with traumatic brain injury (TBI), less is known about the performance of these biomarkers in children. We characterize age-dependent differences in levels of ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) in children without TBI.
METHODS: Plasma biobank specimens from children and adolescents aged 0-<19 years without TBI were obtained, and UCH-L1 and GFAP levels were quantified. The relationship between age and biomarker expression was determined using previously defined aged epochs (<3.5 years, 3.5 years to <11 years, 11 years and older), then biomarker levels were compared with established thresholds for ruling out the need for a head CT in adults with a mild TBI (mTBI) (UCH-L1 400 pg/mL, GFAP 35 pg/mL).
RESULTS: The age range of the 366 control patients was 3 months-18 years. There was a significant negative association between age and GFAP but not UCH-L1. Only 1.4% of samples exceeded the UCH-L1 cutoff; however, 20% of samples exceeded the GFAP cutoff and 100% children younger than 3.5 years had values that exceeded the cutoff.
CONCLUSIONS: Age seems to modify physiologic plasma GFAP levels. Diagnostic cutoffs for TBI based on GFAP but not UCH-L1 and may need to be adjusted in children younger than 11 years.
METHODS: Plasma biobank specimens from children and adolescents aged 0-<19 years without TBI were obtained, and UCH-L1 and GFAP levels were quantified. The relationship between age and biomarker expression was determined using previously defined aged epochs (<3.5 years, 3.5 years to <11 years, 11 years and older), then biomarker levels were compared with established thresholds for ruling out the need for a head CT in adults with a mild TBI (mTBI) (UCH-L1 400 pg/mL, GFAP 35 pg/mL).
RESULTS: The age range of the 366 control patients was 3 months-18 years. There was a significant negative association between age and GFAP but not UCH-L1. Only 1.4% of samples exceeded the UCH-L1 cutoff; however, 20% of samples exceeded the GFAP cutoff and 100% children younger than 3.5 years had values that exceeded the cutoff.
CONCLUSIONS: Age seems to modify physiologic plasma GFAP levels. Diagnostic cutoffs for TBI based on GFAP but not UCH-L1 and may need to be adjusted in children younger than 11 years.
摘要：
目标：尽管越来越多的证据表明血脑生物标志物在成人创伤性脑损伤（TBI）中的临床应用，对这些生物标志物在儿童中的表现知之甚少。我们描述了无TBI儿童中泛素羧基末端水解酶L1（UCH-L1）和神经胶质纤维酸性蛋白（GFAP）水平的年龄依赖性差异。
方法：获得0-19岁无TBI儿童和青少年的血浆生物样本库标本，UCH-L1和GFAP水平进行了量化。年龄与生物标志物表达之间的关系是使用先前定义的年龄（<3.5岁，3.5年至<11年，11岁及以上)，然后将生物标志物水平与确定的阈值进行比较，以排除轻度TBI（mTBI）成人需要进行头部CT（UCH-L1400pg/mL，GFAP35pg/mL)。
结果：366名对照患者的年龄范围为3个月-18岁。年龄与GFAP之间存在显著负相关，但与UCH-L1无关。只有1.4%的样本超过UCH-L1截止值；然而，20%的样本超过GFAP截止值,100%小于3.5岁的儿童的值超过截止值。
结论：年龄似乎改变了生理性血浆GFAP水平。基于GFAP而不是UCH-L1的TBI诊断截止值，可能需要在11岁以下的儿童中进行调整。
方法：获得0-19岁无TBI儿童和青少年的血浆生物样本库标本，UCH-L1和GFAP水平进行了量化。年龄与生物标志物表达之间的关系是使用先前定义的年龄（<3.5岁，3.5年至<11年，11岁及以上)，然后将生物标志物水平与确定的阈值进行比较，以排除轻度TBI（mTBI）成人需要进行头部CT（UCH-L1400pg/mL，GFAP35pg/mL)。
结果：366名对照患者的年龄范围为3个月-18岁。年龄与GFAP之间存在显著负相关，但与UCH-L1无关。只有1.4%的样本超过UCH-L1截止值；然而，20%的样本超过GFAP截止值,100%小于3.5岁的儿童的值超过截止值。
结论：年龄似乎改变了生理性血浆GFAP水平。基于GFAP而不是UCH-L1的TBI诊断截止值，可能需要在11岁以下的儿童中进行调整。
