Differential Disruption of Blood-Brain Barrier in Severe Traumatic Brain Injury
Differential Disruption of Blood-Brain Barrier in Severe Traumatic Brain Injury
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DOI：
10.1007/s12028-013-9933-z
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发表时间：
2014-04-01
影响因子：
3.5
通讯作者：
Ho, Kwok M.
中科院分区：
文献类型：
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作者：
Saw, Melanie M.;Chamberlain, Jenny;Ho, Kwok M.
创伤性脑损伤（TBI）是年轻人死亡和残疾的重要原因，但对该群体血脑屏障（BBB）功能障碍的发生率和特征知之甚少。在这项概念验证研究中，我们试图量化严重 TBI 患者 BBB 功能障碍（定义为脑脊液 (CSF)-血浆白蛋白商数为千分之 0.007）的发生率，并检查血浆和 CSF 蛋白质和电解质水平之间的关系。我们招募了 30 名患者，所有患者均因颅内高压而接受高渗 20% 盐水输注，并在 2017 年接受了脑室外引流。现场。同时获得脑脊液和血液样本。对钠、渗透压、钾、葡萄糖、白蛋白、免疫球蛋白-G 和总蛋白进行生化检测。11 名患者 (37%) 显示出被动 BBB 功能受损的证据，脑脊液-血浆白蛋白商为千分之 0.007。脑脊液-血浆白蛋白商、脑脊液-血浆免疫球蛋白-G商和脑脊液-血浆总蛋白商之间存在很强的正相关性（分别为r = 0.967，P < 0.001和r = 0.995，P < 0.001）。我们还发现，BBB 破坏患者的最大颅内压较高（24 与 21 mmHg，P = 0.029），并且死亡率有增加的趋势（27 % vs. 11 %，P = 0.33）。 总之，被动 BBB 功能障碍在严重 TBI 患者中很常见，可能对渗透疗法的有效性和长期结局产生重要影响。此外，我们的结果表明，脑脊液-血浆总蛋白商（一种易于获得的测量方法）可以用来代替脑脊液-血浆白蛋白商来评估血脑屏障功能障碍。
Traumatic brain injury (TBI) is a significant cause of death and disability in young adults, but not much is known about the incidence and characteristics of blood-brain barrier (BBB) dysfunction in this group. In this proof of concept study, we sought to quantify the incidence of BBB dysfunction (defined as a cerebrospinal fluid (CSF)-plasma albumin quotient of a parts per thousand yen0.007) and examine the relationship between plasma and CSF levels of proteins and electrolytes, in patients with severe TBI.We recruited 30 patients, all of whom were receiving hypertonic 20 % saline infusion for intracranial hypertension and had external ventricular drains in situ. Simultaneous CSF and blood samples were obtained. Biochemical testing was performed for sodium, osmolality, potassium, glucose, albumin, immunoglobulin-G, and total protein.Eleven patients (37 %) showed evidence of impairment of passive BBB function, with a CSF-plasma albumin quotient of a parts per thousand yen0.007. There were strong positive correlations seen among CSF-plasma albumin quotient and CSF-plasma immunoglobulin-G quotient and CSF-plasma total protein quotient (r = 0.967, P < 0.001 and r = 0.995, P < 0.001, respectively). We also found a higher maximum intracranial pressure (24 vs. 21 mmHg, P = 0.029) and a trend toward increased mortality (27 vs. 11 %, P = 0.33) in patients with BBB disruption.In summary, passive BBB dysfunction is common in patients with severe TBI, and may have important implications for effectiveness of osmotherapy and long-term outcomes. Also, our results suggest that the CSF-plasma total protein quotient, a measurement which is readily available, can be used instead of the CSF-plasma albumin quotient for evaluating BBB dysfunction.