A daily temperature rhythm in the human brain predicts survival after brain injury.
A daily temperature rhythm in the human brain predicts survival after brain injury.
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人类大脑的每日温度节律预示着脑损伤后的存活。
DOI：
10.1093/brain/awab466
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发表时间：
2022-06-30
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患者接受干预以达到“正常”的大脑温度;这一参数对人类来说仍然不确定。神经元功能对温度的高度敏感性意味着大脑应该是等温的，但对患者和非人类灵长类动物的观察表明存在显着的时空变化。我们的目的是通过确定健康成人的脑温变化程度来确定患者脑温的临床相关性。我们回顾性筛选了所有入选欧洲创伤性脑损伤神经创伤有效性研究（CENTER-TBI）高分辨率重症监护室子研究的患者的数据。仅纳入了直接脑温测量和无目标温度管理的患者。为了解释患者分析，我们前瞻性招募了40名健康成年人（20名男性，20名女性，20-40岁），使用磁共振波谱进行脑温度测量。参与者在一天的上午、下午和深夜接受扫描。在患者（n = 114）中，脑温范围为32.6至42.3°C，平均脑温（38.5 ± 0.8°C）超过体温（37.5 ± 0.5°C，P < 0.0001）。在100例符合脑温度节律分析的患者中，25例显示每日节律，老年患者的脑温度范围降低（P = 0.018）。在健康受试者中，脑温范围为36.1至40.9°C;平均脑温（38.5 ± 0.4°C）超过口腔温度（36.0 ± 0.5°C），黄体期女性比卵泡期女性和男性高0.36°C（分别为P = 0.0006和P < 0.0001）。温度随着年龄的增长而升高，最明显的是脑深部区域（20年内为0.6°C，P = 0.0002），并且在空间上变化为2.41 ± 0.46°C，其中丘脑温度最高。脑温随时间变化，尤其是深部（0.86°C，P = 0.0001），夜间最低。根据健康数据，我们建立了HEATWAVE-人脑温度的4D地图。在测试HEATWAVE在患者中的临床相关性时，我们发现缺乏每日脑温节律会使重症监护中的死亡几率增加21倍（P = 0.016），而绝对温度最大值或最小值并不能预测结果。然而，平均脑温升高与存活率相关（P = 0.035），而10岁的老龄化使死亡几率增加了11倍（P = 0.0002）。人类大脑的温度比以前推测的要高，而且变化也更大--受年龄、性别、月经周期、大脑区域和一天中的时间的影响。这对温度监测和管理具有重大意义，每日脑温度节律性成为脑损伤后生存率最强的单一预测因素之一。我们的结论是，每天有节奏的大脑温度变化，而不是绝对的大脑温度，是一种方式，其中人类大脑生理学可能是从病理生理学区分。脑损伤后基于温度的治疗是有争议的，因为“正常”人脑温度（TBr）仍然不确定。Rzechorzek等人建立了一个4D人类TBr地图，显示TBr超过体温2-3°C，并因年龄，性别，大脑区域和时间而异。TBr日节律的丧失可靠地预测TBI后的死亡。
Patients undergo interventions to achieve a ‘normal’ brain temperature; a parameter that remains undefined for humans. The profound sensitivity of neuronal function to temperature implies the brain should be isothermal, but observations from patients and non-human primates suggest significant spatiotemporal variation. We aimed to determine the clinical relevance of brain temperature in patients by establishing how much it varies in healthy adults. We retrospectively screened data for all patients recruited to the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High Resolution Intensive Care Unit Sub-Study. Only patients with direct brain temperature measurements and without targeted temperature management were included. To interpret patient analyses, we prospectively recruited 40 healthy adults (20 males, 20 females, 20–40 years) for brain thermometry using magnetic resonance spectroscopy. Participants were scanned in the morning, afternoon, and late evening of a single day. In patients (n = 114), brain temperature ranged from 32.6 to 42.3°C and mean brain temperature (38.5 ± 0.8°C) exceeded body temperature (37.5 ± 0.5°C, P < 0.0001). Of 100 patients eligible for brain temperature rhythm analysis, 25 displayed a daily rhythm, and the brain temperature range decreased in older patients (P = 0.018). In healthy participants, brain temperature ranged from 36.1 to 40.9°C; mean brain temperature (38.5 ± 0.4°C) exceeded oral temperature (36.0 ± 0.5°C) and was 0.36°C higher in luteal females relative to follicular females and males (P = 0.0006 and P < 0.0001, respectively). Temperature increased with age, most notably in deep brain regions (0.6°C over 20 years, P = 0.0002), and varied spatially by 2.41 ± 0.46°C with highest temperatures in the thalamus. Brain temperature varied by time of day, especially in deep regions (0.86°C, P = 0.0001), and was lowest at night. From the healthy data we built HEATWAVE—a 4D map of human brain temperature. Testing the clinical relevance of HEATWAVE in patients, we found that lack of a daily brain temperature rhythm increased the odds of death in intensive care 21-fold (P = 0.016), whilst absolute temperature maxima or minima did not predict outcome. A warmer mean brain temperature was associated with survival (P = 0.035), however, and ageing by 10 years increased the odds of death 11-fold (P = 0.0002). Human brain temperature is higher and varies more than previously assumed—by age, sex, menstrual cycle, brain region, and time of day. This has major implications for temperature monitoring and management, with daily brain temperature rhythmicity emerging as one of the strongest single predictors of survival after brain injury. We conclude that daily rhythmic brain temperature variation—not absolute brain temperature—is one way in which human brain physiology may be distinguished from pathophysiology. Temperature-based treatment after brain injury is controversial because ‘normal’ human brain temperature (TBr) remains undefined. Building a 4D human TBr map, Rzechorzek et al. show that TBr exceeds body temperature by 2–3°C, and varies by age, sex, brain region and time. Loss of a daily TBr rhythm reliably predicts death after TBI.
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DOI：
10.1093/brain/awaa443
发表时间：
2021-04-12
期刊：
Brain : a journal of neurology
影响因子：
--
作者：
Eide, Per Kristian;Vinje, Vegard;Ringstad, Geir
通讯作者：
Ringstad, Geir
影响因子：
56.9
作者：
Conti, Bruno;Sanchez-Alavez, Manuel;Bartfai, Tamas
通讯作者：
Bartfai, Tamas
影响因子：
4.6
作者：
Blowers, Stephen;Marshall, Ian;Valluri, Prashant
通讯作者：
Valluri, Prashant
影响因子：
4.8
作者：
Carney, Nancy;Totten, Annette M.;Ghajar, Jamshid
通讯作者：
Ghajar, Jamshid
影响因子：
16.2
作者：
Banerjee A;Egger R;Long MA
通讯作者：
Long MA