Elevated levels of serum glial fibrillary acidic protein breakdown products in mild and moderate traumatic brain injury are associated with intracranial lesions and neurosurgical intervention.
Elevated levels of serum glial fibrillary acidic protein breakdown products in mild and moderate traumatic brain injury are associated with intracranial lesions and neurosurgical intervention.
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DOI：
10.1016/j.annemergmed.2011.08.021
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发表时间：
2012-06
影响因子：
6.2
通讯作者：
Wang, Kevin K. W.
中科院分区：
文献类型：
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作者：
Papa, Linda;Lewis, Lawrence M.;Falk, Jay L.;Zhang, Zhiqun;Silvestri, Salvatore;Giordano, Philip;Brophy, Gretchen M.;Demery, Jason A.;Dixit, Neha K.;Ferguson, Ian;Liu, Ming Cheng;Mo, Jixiang;Akinyi, Linnet;Schmid, Kara;Mondello, Stefania;Robertson, Claudia S.;Tortella, Frank C.;Hayes, Ronald L.;Wang, Kevin K. W.
本研究检查了与对照组相比，轻度和中度TBI患者的血清GFAP分解产物（GFAP-BDP）水平是否升高，以及它们是否与CT扫描（+CT）和神经外科干预（NSI）的创伤性颅内病变相关。这项前瞻性队列研究招募了在钝性头部创伤后出现意识丧失、遗忘症或定向障碍且GCS 9-15的到3个1级创伤中心就诊的成人患者。对照组包括正常未受伤的对照组和因骨科损伤或无TBI的MVC而到艾德就诊的创伤对照组。在所有患者中在损伤后4小时内获得血液样品，并通过ELISA测量GFAP-BDP（ng/ml）。在入组的307例患者中，108例为TBI患者（97例GCS 13-15，11例GCS 9-12），199例为对照组（176例正常对照组，16例MVC对照组和7例骨科对照组）。ROC曲线表明，早期GFAP-BDP水平能够区分TBI与未损伤对照，AUC为0.90（95%CI 0.86-0.94），区分GCS 15的TBI，AUC为0.88（95%CI 0.82-0.93）。32例TBI患者（30%）在CT上有病变。区分CT病变患者与无CT病变患者的AUC为0.79（95%CI 0.69-0.89）。此外，用于区分NSI与无NSI的ROC曲线产生的AUC为0.87（95%CI 0.77-0.96）。GFAP-BDP在损伤后1小时内可在血清中检测到，并与损伤严重程度的测量相关，包括GCS评分、CT病变和神经外科干预。在临床应用之前，需要进一步的研究来验证这些发现。
This study examined whether serum levels of GFAP breakdown products (GFAP-BDP) were elevated in mild and moderate TBI compared to controls and if they were associated with traumatic intracranial lesions on CT scan (+CT) and having a neurosurgical intervention (NSI). This prospective cohort study enrolled adult patients presenting to three Level 1 Trauma Centers following blunt head trauma with loss of consciousness, amnesia, or disorientation and a GCS 9–15. Control groups included normal uninjured controls and trauma controls presenting to the ED with orthopedic injuries or an MVC without TBI. Blood samples were obtained in all patients within 4 hours of injury and measured by ELISA for GFAP-BDP (ng/ml). Of the 307 patients enrolled, 108 were TBI patients (97 with GCS 13–15, and 11 with GCS 9–12) and 199 were controls (176 normal controls and 16 MVC controls and 7 orthopedic controls). ROC curves demonstrated that early GFAP-BDP levels were able to distinguish TBI from uninjured controls with an AUC of 0.90 (95%CI 0.86–0.94) and differentiated TBI with a GCS 15 with an AUC 0.88 (95%CI 0.82–0.93). Thirty two TBI patients (30%) had lesions on CT. The AUC for discriminating those patients with CT lesions versus those without CT lesions was 0.79 (95%CI 0.69–0.89). Moreover, the ROC curve for distinguishing NSI from no NSI yielded an AUC of 0.87 (95%CI 0.77–0.96). GFAP-BDP is detectable in serum within an hour of injury and is associated with measures of injury severity including the GCS score, CT lesions and neurosurgical intervention. Further study is required to validate these findings before clinical application.
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影响因子：
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作者：
Berrington de González A;Mahesh M;Kim KP;Bhargavan M;Lewis R;Mettler F;Land C
通讯作者：
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影响因子：
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