■运动相关脑震荡(SRC),一种轻度创伤性脑损伤,是碰撞运动中普遍存在的现象。没有成熟的方法来追踪SRC后的神经生物学恢复。
■为了检查经历SRC的澳大利亚足球运动员的血清胶质纤维酸性蛋白(GFAP)和神经丝光(NfL)的水平。
■一项从2021年4月10日至2022年9月17日的队列研究通过维多利亚州业余足球协会进行,墨尔本,澳大利亚。参与者包括有或没有SRC的成年澳大利亚足球运动员。数据分析从2023年5月26日至2024年3月27日进行。
■运动相关脑震荡,定义为至少1个可观察到的体征和/或2个或更多个症状。
■主要结果是24小时的血清GFAP和NfL水平,和1、2、4、6、8、12和26周。次要结果是症状,认知表现,回到训练时间。
■81名SRC患者(平均年龄,22.8[IQR,21.3-26.0]岁;89%为男性)和56名对照个体(平均年龄,24.6[IQR,22.4-27.3]岁;96%的男性)完成了1057次合格测试中的945次。与对照参与者相比,SRC患者在24小时表现出更高的GFAP水平(自然对数平均差[MD],pg/mL,0.66[95%CI,0.50-0.82])和4周(MD,0.17[95%CI,0.02-0.32]),和NfL从1到12周(1周MD,0.31[95%CI,0.12-0.51];2周MD,0.38[95%CI,0.19-0.58];4周MD,0.31[95%CI,0.12-0.51];6周MD,0.27[95%CI,0.07-0.47];8周MD,0.36[95%CI,0.15-0.56];和12周MD,0.25[95%CI,0.04-0.46])。生长混合模型确定了2个GFAP亚组:极端延长(16%)和中度瞬时(84%)。对于NFL,确定了3个亚组:极端延长(7%),适度延长(15%),和最小或没有变化(78%)。报告意识丧失(LOC)的SRC患者(SRC病例的33%)在24小时时GFAP较高(MD,1.01[95%CI,0.77-1.24]),1周(MD,0.27[95%CI,0.06-0.49]),2周(MD,0.21[95%CI,0.004-0.42])和4周(MD,0.34[95%CI,0.13-0.55]),从1周到12周,NfL更高(1周MD,0.73[95%CI,0.42-1.03];2周MD,0.91[95%CI,0.61-1.21];4周MD,0.90[95%CI,0.59-1.20];6周MD,0.81[95%CI,0.50-1.13];8周MD,0.73[95%CI,0.42-1.04];和12周MD,0.54[95%CI,0.22-0.85])与无LOC的SRC参与者相比。与中等亚组相比,GFAP极端组的恢复训练时间更长(发生率比[IRR],1.99[95%CI,1.69-2.34];NFL极值(IRR,3.24[95%CI,2.63-3.97])和中等(内部收益率,1.43[95%CI,1.18-1.72])亚组与最小亚组相比,对于有LOC的人与没有LOC的人(IRR,1.65[95%CI,1.41-1.93])。
■在这项队列研究中,SRC案例的一个子集,特别是那些有LOC的,显示GFAP和NfL水平的增加和延长,持续了至少4周。这些发现表明,连续生物标志物测量可以识别此类病例,根据神经生物学恢复指导回归游戏决策。虽然需要进一步调查,延长的生物标志物升高与LOC之间的关联可能支持对于具有该临床特征的运动员使用更保守的回归比赛时间表.
UNASSIGNED: Sport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC.
UNASSIGNED: To examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian
football athletes who experience SRC.
UNASSIGNED: A cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur
Football Association, Melbourne, Australia. Participants included adult Australian
football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024.
UNASSIGNED: Sport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms.
UNASSIGNED: Primary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times.
UNASSIGNED: Eighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93]).
UNASSIGNED: In this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.