Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury.
Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury.
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DOI：
10.1001/jamaneurol.2016.0039
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发表时间：
2016-05-01
期刊：
影响因子：
29
通讯作者：
Hack DC
中科院分区：
文献类型：
--
作者：
Papa L;Brophy GM;Welch RD;Lewis LM;Braga CF;Tan CN;Ameli NJ;Lopez MA;Haeussler CA;Mendez Giordano DI;Silvestri S;Giordano P;Weber KD;Hill-Pryor C;Hack DC
胶质纤维酸性蛋白 (GFAP) 和泛素 C 末端水解酶 L1 (UCH-L1) 已被广泛研究，并在疑似创伤性脑损伤 (TBI) 和脑震荡方面显示出临床用途。随着时间的推移了解其诊断准确性将有助于将其转化为临床实践。评估在急诊科就诊的一大批创伤患者的 GFAP 和 UCH-L1 时间特征，并评估其随时间的变化（单独和组合）的诊断准确性，以检测轻度至中度 TBI (MMTBI)、头部计算机断层扫描 (CT) 上的创伤性颅内病变和神经外科干预。这项前瞻性队列研究纳入了 2010 年 3 月 1 日至 2014 年 3 月 5 日在一级创伤中心就诊的成年创伤患者。所有患者都接受了严格的筛查，以确定他们是否经历过 MMTBI（钝性头部创伤，伴有意识丧失、健忘症或迷失方向，格拉斯哥昏迷量表评分为 9-15）。在接受评估的 3025 名创伤患者中，1030 名符合入组资格标准，446 名拒绝参与。 584 名患者在受伤后 4 小时内获得了初始血液样本。在受伤后4、8、12、16、20、24、36、48、60、72、84、96、108、120、132、144、156、168和180小时重复进行血液采样。 MMTBI 的诊断、头部 CT 扫描是否存在创伤性颅内病变以及神经外科干预。 7 天内，从 584 名患者（平均 [SD] 年龄，40 [16] 岁；62.0% [584 人中的 362 人] 为男性）总共抽取了 1831 份血液样本。受伤后 1 小时内即可检测到 GFAP 和 UCH-L1。 GFAP 在受伤后 20 小时达到峰值，并在 72 小时内缓慢下降。 UCH-L1迅速上升，并在受伤后8小时达到峰值，并在48小时内迅速下降。在 1 周的过程中，GFAP 表现出检测 MMTBI 的曲线下面积的诊断范围为 0.73 (95% CI，0.69–0.77) 至 0.94 (95% CI，0.78–1.00)，UCH-L1 表现出的诊断范围为 0.30 (95% CI，0.02–0.50) 至 0.67 (95% CI， 0.53–0.81）。对于 CT 上的颅内病变检测，GFAP 曲线下面积的诊断范围为 0.80 (95% CI, 0.67–0.92) 至 0.97 (95% CI, 0.93–1.00)，而 GFAP 曲线下面积的诊断范围为 0.31 (95% CI, 0–0.63) 至 0.77 (95% CI, 0.68–0.85)。 UCH-L1。为了区分接受和未接受神经外科干预的患者，GFAP 的范围为 0.91 (95% CI，0.79–1.00) 至 1.00 (95% CI，1.00–1.00)，UCH-L1 的范围为 0.50 (95% CI，0–1.00) 至 0.92 (95% CI，1.00)。 0.83–1.00）。 7 天内，GFAP 在检测 MMTBI、CT 病变和神经外科干预方面表现一致。 UCH-L1 在损伤后早期表现最好。
Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have been widely studied and show promise for clinical usefulness in suspected traumatic brain injury (TBI) and concussion. Understanding their diagnostic accuracy over time will help translate them into clinical practice. To evaluate the temporal profiles of GFAP and UCH-L1 in a large cohort of trauma patients seen at the emergency department and to assess their diagnostic accuracy over time, both individually and in combination, for detecting mild to moderate TBI (MMTBI), traumatic intracranial lesions on head computed tomography (CT), and neurosurgical intervention. This prospective cohort study enrolled adult trauma patients seen at a level I trauma center from March 1, 2010, to March 5, 2014. All patients underwent rigorous screening to determine whether they had experienced an MMTBI (blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale score of 9–15). Of 3025 trauma patients assessed, 1030 met eligibility criteria for enrollment, and 446 declined participation. Initial blood samples were obtained in 584 patients enrolled within 4 hours of injury. Repeated blood sampling was conducted at 4, 8, 12, 16, 20, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180 hours after injury. Diagnosis of MMTBI, presence of traumatic intracranial lesions on head CT scan, and neurosurgical intervention. A total of 1831 blood samples were drawn from 584 patients (mean [SD] age, 40 [16] years; 62.0% [362 of 584] male) over 7 days. Both GFAP and UCH-L1 were detectible within 1 hour of injury. GFAP peaked at 20 hours after injury and slowly declined over 72 hours. UCH-L1 rose rapidly and peaked at 8 hours after injury and declined rapidly over 48 hours. Over the course of 1 week, GFAP demonstrated a diagnostic range of areas under the curve for detecting MMTBI of 0.73 (95% CI, 0.69–0.77) to 0.94 (95% CI, 0.78–1.00), and UCH-L1 demonstrated a diagnostic range of 0.30 (95% CI, 0.02–0.50) to 0.67 (95% CI, 0.53–0.81). For detecting intracranial lesions on CT, the diagnostic ranges of areas under the curve were 0.80 (95% CI, 0.67–0.92) to 0.97 (95% CI, 0.93–1.00)for GFAP and 0.31 (95% CI, 0–0.63) to 0.77 (95% CI, 0.68–0.85) for UCH-L1. For distinguishing patients with and without a neurosurgical intervention, the range for GFAP was 0.91 (95% CI, 0.79–1.00) to 1.00 (95% CI, 1.00–1.00), and the range for UCH-L1 was 0.50 (95% CI, 0–1.00) to 0.92 (95% CI, 0.83–1.00). GFAP performed consistently in detecting MMTBI, CT lesions, and neurosurgical intervention across 7 days. UCH-L1 performed best in the early postinjury period.
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影响因子：
4.2
作者：
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