■基于血液的生物标志物可以阐明潜在的神经病理学,并可能有助于青少年运动相关脑震荡(SRC)的临床管理。
■研究青少年SRC与血浆生物标志物之间的关联。
■加拿大体育和诊所环境的前瞻性队列研究(高中和社区体育监测以减少脑震荡及其后果研究;2019年9月至2022年11月)。参与者是849名青少年(10-18岁)运动参与者的便利样本,并带有血液样本。对2023年2月至9月的数据进行了分析。
■血液收集和临床试验季前(未受伤)以及SRC后的随访(即,≤72小时,1周,每两周一次,直到医疗许可返回播放[RTP])。
■血浆胶质纤维酸性蛋白(GFAP),泛素c端水解酶-L1(UCH-L1),神经丝光(NfL),并测定总tau(t-tau)。在未受伤和SRC后间隔(受伤后第0-3、4-10、11-28和>28天)之间进行生物标志物水平的组水平比较,考虑到年龄和性别作为修饰。二次分析探讨了生物标志物浓度与临床结果之间的关联(运动脑震荡评估工具,第五版[SCAT5]症状评分和RTP时间)。
■这项研究包括695名未受伤参与者的1023份血浆标本(467名男性参与者[67.2%];中位[IQR]年龄,15.90[15.13-16.84]岁)和154名脑震荡参与者(78名男性参与者[51.0%];中位[IQR]年龄,16.12[15.31-17.11]年)。发现GFAP相对于未受伤水平的急性(PID0-3)差异(女性参与者:增加17.8%;β=0.164;95%CI,0.064至0.263;P=.001;男性参与者:增加17.1%;β=0.157;95%CI,0.086至0.229;P<.001),UCH-L1(女性参与者:43.4%增加;β=0.361;95%CI,0.125至0.596;P=0.003),NfL(男性参与者:增加19.0%;β=0.174;95%CI,0.087至0.261;P<.001),和t-tau(女性参与者:-22.9%;β=-0.260;95%CI,-0.391至-0.130;P<.001;男性参与者:-18.4%;β=-0.203;95%CI,-0.300至-0.106;P<.001)。与未损伤组相比,在PID4至10、11至28和大于28处观察到所有生物标志物的差异。GFAP,NFL,t-tau与多个PID间隔的SCAT5症状评分相关。SRC后28天后较高的GFAP与较早清除RTP相关(危险比,4.78;95%CI,1.59至14.31;P=0.01)。男性参与者表现出较低的GFAP(-9.7%),但与女性参与者相比,UCH-L1较高(21.3%)。年龄与较低的GFAP(每年-5.4%)和t-tau(每年-5.3%)相关。
■在这项849名青少年的队列研究中,血浆生物标志物在未受伤的参与者和脑震荡的参与者之间有所不同,支持他们继续使用来了解脑震荡神经病理学。年龄和性别是关键的考虑因素,因为这些生物标志物正在向临床验证发展。
UNASSIGNED: Blood-based biomarkers may clarify underlying neuropathology and potentially assist in clinical management of adolescents with sport-related concussion (SRC).
UNASSIGNED: To investigate the association between SRC and plasma biomarkers in adolescents.
UNASSIGNED: Prospective cohort study in Canadian sport and clinic settings (Surveillance in High Schools and Community Sport to Reduce Concussions and Their Consequences study; September 2019 to November 2022). Participants were a convenience sample of 849 adolescent (ages 10-18 years) sport participants with blood samples. Data were analyzed from February to September 2023.
UNASSIGNED: Blood collection and clinical testing preseason (uninjured) and post-SRC follow-ups (ie, ≤72 hours, 1 week, and biweekly until medical clearance to return to play [RTP]).
UNASSIGNED: Plasma glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light (NfL), and total tau (t-tau) were assayed. Group-level comparisons of biomarker levels were conducted between uninjured and post-SRC intervals (postinjury day [PID] 0-3, 4-10, 11-28, and >28) considering age and sex as modifiers. Secondary analyses explored associations between biomarker concentrations and clinical outcomes (Sport Concussion Assessment Tool, Fifth Edition [SCAT5] symptom scores and time to RTP).
UNASSIGNED: This study included 1023 plasma specimens from 695 uninjured participants (467 male participants [67.2%]; median [IQR] age, 15.90 [15.13-16.84] years) and 154 participants with concussion (78 male participants [51.0%]; median [IQR] age, 16.12 [15.31-17.11] years). Acute (PID 0-3) differences relative to uninjured levels were found for GFAP (female participants: 17.8% increase; β = 0.164; 95% CI, 0.064 to 0.263; P = .001; male participants: 17.1% increase; β = 0.157; 95% CI, 0.086 to 0.229; P < .001), UCH-L1 (female participants: 43.4% increase; β = 0.361; 95% CI, 0.125 to 0.596; P = .003), NfL (male participants: 19.0% increase; β = 0.174; 95% CI, 0.087 to 0.261; P < .001), and t-tau (female participants: -22.9%; β = -0.260; 95% CI, -0.391 to -0.130; P < .001; male participants: -18.4%; β = -0.203; 95% CI, -0.300 to -0.106; P < .001). Differences were observed for all biomarkers at PID 4 to 10, 11 to 28, and greater than 28 compared with uninjured groups. GFAP, NfL, and t-tau were associated with SCAT5 symptom scores across several PID intervals. Higher GFAP after 28 days post-SRC was associated with earlier clearance to RTP (hazard ratio, 4.78; 95% CI, 1.59 to 14.31; P = .01). Male participants exhibited lower GFAP (-9.7%), but higher UCH-L1 (21.3%) compared with female participants. Age was associated with lower GFAP (-5.4% per year) and t-tau (-5.3% per year).
UNASSIGNED: In this cohort study of 849 adolescents, plasma biomarkers differed between uninjured participants and those with concussions, supporting their continued use to understand concussion neuropathology. Age and sex are critical considerations as these biomarkers progress toward clinical validation.