Diurnal brain temperature rhythms and mortality after brain injury: a prospective and retrospective cohort study
Diurnal brain temperature rhythms and mortality after brain injury: a prospective and retrospective cohort study
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脑损伤后的昼夜脑温节律和死亡率：一项前瞻性和回顾性队列研究
DOI：
10.1101/2021.01.23.21250327
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Rzechorzek N
中科院分区：
文献类型：
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作者：
Rzechorzek N
目的探讨颅脑外伤（TBI）后脑温（TBr）变化的临床意义。（健康受试者）和回顾性（TBI患者）手臂。设置英国单一神经影像学站点（前瞻性研究组）;为欧洲TBI神经创伤有效性合作研究做出贡献的重症监护场所（CENTER-TBI）高分辨率ICU（HR ICU）子研究（回顾性组）：招募40名20-40岁的健康成人进行无创脑测温，以及截至2020年5月直接测量TBr且未接受目标温度管理（TTM）的所有患者主要结果测量TBr的日变化（健康参与者）;重症监护死亡结果在健康受试者中，平均TBr（38.5 SD 0.4°C）高于口腔温度（36.0 SD 0.5°C），黄体期女性比卵泡期女性和男性高0.36°C（95%置信区间分别为0.17至0.55，P=0.0006和0.23至0.49，P<0.0001）。TBr随年龄增长而增加，在脑深部区域最明显（20年内为0.6°C; 0.11至1.07，P=0.0002）。平均最大空间TBr范围为2.41（SD 0.46）°C，最高温度在丘脑。TBr随时间变化显著，尤其是在脑深部（0.86°C; 0.37 ~ 1.26，P=0.0001），在傍晚最低。参与者的皮质白色物质的日TBrin范围为37.0至40.3°C。在TBI患者（n=114）中，平均TBr（38.5 SD 0.8°C）显著高于体温（TBo 37.5 SD 0.5°C; P<0.0001），范围为32.6至42.3°C。只有25/110例患者表现出昼夜体温节律;老年患者的体温降低（P=0.018），25/113例患者在重症监护中死亡。缺乏每日TBr节律或年龄增加10岁，死亡几率分别增加12倍和11倍（节律死亡的OR为0.09; 0.01 - 0.84，P=0.035，1岁时死亡的OR为1.10; 1.05 - 1.16，P=0.0002）。平均TBr与生存率呈正相关（死亡OR为0.45，1°C升高; 0.21至0.96，P=0.040）。我们的健康TBr的4维参考资源可以指导多种临床环境中TBr数据的解释。TBI患者的每日体温变化经常中断或不存在，其中TBr变化比绝对TBr具有更大的预后作用。缺乏每日TBR节律的老年TBI患者在重症监护中死亡风险最大。需要适当的对照试验来确认TBr节律性与患者结果的预测能力，以及TTM协议在脑损伤患者中的临床效用。注册UK CRN NIHR CPMS 42644; ClinicalTrials.gov编号，NCT 02210221。概要方框关于该主题已知的内容脑温度（TBr）可以通过颅内探针直接测量脑损伤患者，但是这种方法不能用于健康个体。TBr可以使用磁共振波谱（MRS）非侵入性地测量，但是这种方法不适合于大多数脑损伤患者。由于TBr健康的生理参考范围尚未建立，患者TBr变化的临床相关性是未知的，TTM在神经重症监护中的应用仍存在争议。本研究为健康成人TBR在三个临床相关时间点的参考图，可以指导在多个临床环境中直接或通过MRS测量的TBR的解释。我们的结果表明，昼夜TTM的丢失可能是一个重要的因素。
ObjectiveTo determine the clinical relevance of brain temperature (TBr) variation in patients after traumatic brain injury (TBI).DesignCohort study with prospective (healthy participant) and retrospective (TBI patient) arms.SettingSingle neuroimaging site in the UK (prospective arm); intensive care sites contributing to the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) High Resolution ICU (HR ICU) Sub-Study (retrospective arm).Participants40 healthy adults aged 20-40 years recruited for non-invasive brain thermometry and all patients up to May 2020 that hadTBrmeasured directly and were not subjected to Targeted Temperature Management (TTM).Main outcome measuresA diurnal change inTBr(healthy participants); death in intensive care (patients).ResultsIn healthy participants, meanTBr(38.5 SD 0.4°C) was higher than oral temperature (36.0 SD 0.5°C), and 0.36°C higher in luteal females relative to follicular females and males (95% confidence interval 0.17 to 0.55, P=0.0006 and 0.23 to 0.49, P<0.0001, respectively).TBrincreased with age, most notably in deep brain regions (0.6°C over 20 years; 0.11 to 1.07, P=0.0002). The mean maximal spatialTBrrange was 2.41 (SD 0.46)°C, with highest temperatures in the thalamus.TBrvaried significantly by time of day, especially in deep brain regions (0.86°C; 0.37 to 1.26, P=0.0001), and was lowest in the late evening. DiurnalTBrin cortical white matter across participants ranged from 37.0 to 40.3°C. In TBI patients (n=114), meanTBr(38.5 SD 0.8°C) was significantly higher than body temperature (TBo37.5 SD 0.5°C; P<0.0001) and ranged from 32.6 to 42.3°C. Only 25/110 patients displayed a diurnal temperature rhythm;TBramplitude was reduced in older patients (P=0.018), and 25/113 patients died in intensive care. Lack of a dailyTBrrhythm, or an age increase of 10 years, increased the odds of death 12-fold and 11-fold, respectively (OR for death with rhythm 0.09; 0.01 to 0.84, P=0.035 and for death with ageing by 1 year 1.10; 1.05 to 1.16, P=0.0002). MeanTBrwas positively associated with survival (OR for death 0.45 for 1°C increase; 0.21 to 0.96, P=0.040).ConclusionsHealthyTBrexceedsTBoand varies by sex, age, menstrual cycle, brain region, and time of day. Our 4-dimensional reference resource for healthyTBrcan guide interpretation ofTBrdata in multiple clinical settings. Daily temperature variation is frequently disrupted or absent in TBI patients, in whichTBrvariation is of greater prognostic use than absoluteTBr. Older TBI patients lacking a dailyTBrrhythm are at greatest risk of death in intensive care. Appropriately controlled trials are needed to confirm the predictive power ofTBrrhythmicity in relation to patient outcome, as well as the clinical utility of TTM protocols in brain-injured patients.RegistrationUK CRN NIHR CPMS 42644; ClinicalTrials.gov number, NCT02210221.SUMMARY BOXWhat is already known on this topicBrain temperature (TBr) can be measured directly in brain-injured patients via intracranial probe, but this method cannot be used in healthy individuals.TBrcan be measured non-invasively using magnetic resonance spectroscopy (MRS), but this method is not appropriate for most brain-injured patients.Since physiological reference ranges forTBrin health have not been established, the clinical relevance ofTBrvariation in patients is unknown, and the use of TTM in neurocritical care remains controversial.What this study addsA reference map for healthy adultTBrat three clinically-relevant time points that can guide interpretation ofTBrmeasured directly, or by MRS, in multiple clinical settings.Our results suggest that loss of diurnal …
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Maeno E：“由于体积调节紊乱导致的正常细胞收缩是细胞凋亡的早期先决条件。”Proc Natl Acad Sci USA。
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衰老大脑的时间神经内分泌标志物
DOI：
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发表时间：
1996
期刊：
Aging
影响因子：
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作者：
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影响因子：
4.8
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通讯作者：
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DOI：
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发表时间：
2020
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作者：
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