Early identification of secondary brain damage in subarachnoid hemorrhage: A role for glial fibrillary acidic protein
Early identification of secondary brain damage in subarachnoid hemorrhage: A role for glial fibrillary acidic protein
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DOI：
10.1089/neu.2006.23.1179
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发表时间：
2006-07-01
影响因子：
4.2
通讯作者：
Thompson, Edward J.
中科院分区：
文献类型：
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作者：
Petzold, Axel;Keir, Geoffrey;Thompson, Edward J.
继发性脑缺血对蛛网膜下腔出血(SAH)患者的预后有不利影响。星形胶质细胞容易受到缺血的影响，在受到攻击时会释放出胶质纤维酸性蛋白(GFAP)。在这项研究中，我们跟踪观察了9名SAH患者，他们接受了脑室外引流治疗继发性脑积水。每天收集脑脊液(CSF)长达14天。用标准的ELISA法测定脑脊液中GFAP的含量。在本组病例中，83/89(93%)的脑脊液标本中GFAP含量呈病理性升高。第1天最高(中位数为47.64 ng/mL)，第3天降至11.19 ng/mL，10天后稳定在约1 ng/mL。在死亡患者中，脑脊液中GFAP水平在血管痉挛的高危期显著升高，第6天中位数为21.76 ng/mL，而存活患者为2.62 ng/mL(p=0.037)。本研究提示脑脊液中GFAP水平对蛛网膜下腔出血有预后价值。此外，幸存者(快速洗出)和死亡者(次级峰值)之间GFAP水平斜率的差异可能有助于区分原发脑损伤和因迟发性脑缺血引起的继发性脑损伤。
Secondary ischaemic deficit adversely affects outcome in patients with subarachnoid hemorrhage (SAH). Astrocytes are vulnerable to ischemia, releasing glial fibrillary acidic protein (GFAP) when challenged. In this study, we followed nine patients with SAH who underwent extra-ventricular drainage for the management of secondary hydrocephalus. Cerebrospinal fluid (CSF) was collected daily for up to 14 days. CSF GFAP was quantified using a standard ELISA. In the patients, we found that the CSF GFAP values were pathologically elevated in 83/89 (93%) of the CSF samples. The levels were highest on day 1 (median = 47.64 ng/mL) and decreased to 11.19 ng/mL on day 3, leveling out at approximately 1 ng/mL after 10 days. In non-survivors, a secondary rise of GFAP levels became significant during the high-risk period for vasospasm, with median levels of 21.76 ng/mL compared to 2.62 ng/mL in the survivors (p = 0.037) on day 6. This study suggests that CSF GFAP levels are of prognostic value in SAH. Additionally, the difference in the slope of GFAP levels between survivors (rapid wash-out) and non-survivors (secondary peaks) may allow differentiation between primary brain injury from secondary brain damage due to delayed cerebral ischaemia.