Glial fibrillary acidic protein as a biomarker for periventricular white matter injury.
Glial fibrillary acidic protein as a biomarker for periventricular white matter injury.
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DOI：
10.1016/j.ajog.2013.02.049
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发表时间：
2013-07
影响因子：
9.8
通讯作者：
Graham, Ernest M.
中科院分区：
文献类型：
--
作者：
Stewart, Amanda;Tekes, Aylin;Huisman, Thierry A. G. M.;Jennings, Jacky M.;Allen, Marilee C.;Northington, Frances J.;Everett, Allen D.;Graham, Ernest M.
脑室周围白质损伤 (PWMI) 是脑瘫的先兆，传统上要到出生后 6 周才能通过头部超声诊断出来。我们试图确定早期新生儿神经胶质纤维酸性蛋白 (GFAP) 水平是否可以识别低出生体重（< 2500 克）婴儿的 PWMI。 2011 年 4 月 4 日至 2011 年 6 周时，每例 PWMI 头部超声检查均与随后 2 个头部超声检查正常的新生儿的胎龄和分娩方式相匹配。在出生时、新生儿重症监护病房 (NICU) 入院时以及出生后第 1-4 天每天测量脐带血中的 GFAP。在这 2 年期间，将 21 名胎龄为 27.4±3.3 周的 PWMI 病例与 42 名对照者进行了比较。两组剖宫产率均为61.9%。脐带血或 NICU 入院时 GFAP 没有显着差异，但在第 1 天（中位数，5%–95%；0, 0–0.98 ng/mL 病例；0,0–0.06 ng/mL 对照，P=0.03）、第 2 天（0, 0–1.21 ng/mL；0, 0–0.05 ng/mL；P=0.02）显着升高第 3 天（0.05，0–0.33 ng/mL；0、0–0.04 ng/mL，P=0.004）和第 4 天（0.02，0–1.03 ng/mL；0、0–0.05 ng/mL，P<0.001）。调整先兆子痫、产前类固醇给药和新生儿慢性肺病后，从生命第 1 天到第 4 天，随着 GFAP 水平的增加，发生 PWMI 的几率显着增加。出生后不久通过血液检测 GFAP 来预测 PWMI 的能力为快速识别婴儿进行早期干预提供了可能性，并为合格的新疗法提供了基准，以改善神经发育结果。
Periventricular white matter injury (PWMI), a precursor of cerebral palsy, is traditionally not diagnosed until 6 weeks of life by head ultrasound. We sought to determine if early neonatal glial fibrillary acidic protein (GFAP) levels could identify PWMI in low birth weight (< 2500 grams) infants. Each case with PWMI on head ultrasound at 6 weeks from 4/09-4/11 was matched by gestational age and mode of delivery to 2 subsequent neonates with a normal head ultrasound. GFAP was measured in cord blood at birth, at neonatal intensive care unit (NICU) admission, and daily on days 1–4 of life. During this 2 year period, 21 cases with PWMI with gestational age 27.4±3.3 weeks were compared to 42 controls. The incidence of cesarean delivery was 61.9% in both groups. GFAP was not significantly different in cord blood or at NICU admission, but was significantly elevated on day 1 (median, 5%–95%; 0, 0–0.98 ng/mL cases; 0,0–0.06 ng/mL controls, P=0.03), day 2 (0, 0–1.21 ng/mL; 0, 0–0.05 ng/mL; P=0.02), day 3 (0.05, 0–0.33 ng/mL; 0, 0–0.04 ng/mL, P=0.004) and day 4 (0.02, 0–1.03 ng/mL; 0, 0–0.05 ng/mL, P<0.001). The odds of developing PWMI significantly increased with increasing levels of GFAP from day 1 to day 4 of life adjusting for preeclampsia, antenatal steroid administration and neonatal chronic lung disease. The ability to predict PWMI with a blood test for GFAP shortly after birth opens the possibility for rapid identification of infants for early intervention and provides a benchmark for qualifying new therapies to improve neurodevelopmental outcomes.
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