背景:这项研究调查了严重创伤性脑损伤(sTBI)后1年和10-15年,脑室脑脊液(CSF)中生物标志物神经丝光(NfL)和神经胶质纤维酸性蛋白(GFAP)浓度与临床结果的关系。
方法:这项研究纳入了Sahlgrenska大学医院神经重症监护病房的sTBI患者,哥德堡,瑞典。如果患者的格拉斯哥昏迷评分≤8对应于反应水平评分≥4,则认为损伤严重。在2周期间从心室导管收集CSF。用酶联免疫吸附试验分析CSF中NfL和GFAP的浓度。格拉斯哥结果量表(GOS)用于评估1年和10-15年的结果。在调整了年龄和以前的神经系统疾病后,对结果GOS1(死亡)或GOS2-5(存活)和GOS1-3(差)或GOS4-5(好)与独立连续变量(NfL和GFAP)进行逻辑回归.
结果:调查了53例sTBI患者;文章中介绍了47例成年人,和6名儿童(7-18岁)在补充1中描述。NfL的CSF浓度在创伤后2周内逐渐增加,而GFAP浓度在第3-4天达到峰值。增加NfL和GFAPCSF浓度增加创伤后1年GOS1-3结局的几率(比值比[OR]1.73,95%置信区间[CI]1.07-2.80,p=0.025;和OR1.61,95%CI1.09-2.37,p=0.016,分别)。同样,CSF中NfL和GFAP浓度的升高增加了创伤后10-15年GOS1-3结局的几率(OR2.04,95%CI1.05-3.96,p=0.035;OR1.60,95%CI1.02-2.00,p=0.040).
结论:这项研究表明,CSF中初始高浓度的NfL和GFAP都与sTBI后1年和10-15年GOS1-3结局的几率更高相关,暗示其作为未来预后标志物的潜在用途。
BACKGROUND: This study investigated trajectory profiles and the association of concentrations of the biomarkers neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) in ventricular cerebrospinal fluid (CSF) with clinical outcome at 1 year and 10-15 years after a severe traumatic brain injury (sTBI).
METHODS: This study included patients with sTBI at the Neurointensive Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. The injury was regarded as severe if patients had a Glasgow Coma Scale ≤ 8 corresponding to Reaction Level Scale ≥ 4. CSF was collected from a ventricular catheter during a 2-week period. Concentrations of NfL and GFAP in CSF were analyzed with enzyme-linked immunosorbent assay. The Glasgow Outcome Scale (GOS) was used to assess the 1-year and 10-15-year outcomes. After adjustment for age and previous neurological diseases, logistic regression was performed for the outcomes GOS 1 (dead) or GOS 2-5 (alive) and GOS 1-3 (poor) or GOS 4-5 (good) versus the independent continuous variables (NfL and GFAP).
RESULTS: Fifty-three patients with sTBI were investigated; forty-seven adults are presented in the article, and six children (aged 7-18 years) are described in Supplement 1. The CSF concentrations of NfL gradually increased over 2 weeks post trauma, whereas GFAP concentrations peaked on days 3-4. Increasing NfL and GFAP CSF concentrations increased the odds of GOS 1-3 outcome 1 year after trauma (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.07-2.80, p = 0.025; and OR 1.61, 95% CI 1.09-2.37, p = 0.016, respectively). Similarly, increasing CSF concentrations of NfL and GFAP increased the odds for GOS 1-3 outcome 10-15 years after trauma (OR 2.04, 95% CI 1.05-3.96, p = 0.035; and OR 1.60, 95% CI 1.02-2.00, p = 0.040).
CONCLUSIONS: This study shows that initial high concentrations of NfL and GFAP in CSF are both associated with higher odds for GOS 1-3 outcome 1 year and 10-15 years after an sTBI, implicating its potential usage as a prognostic marker in the future.