Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury
Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury
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DOI：
10.1136/emermed-2020-209471
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发表时间：
2021-12-15
影响因子：
3.1
通讯作者：
Takala, Riikka S. K.
中科院分区：
文献类型：
--
作者：
Koivikko, Pia;Posti, Jussi P.;Takala, Riikka S. K.
背景 人们对血液生物标志物作为急性创伤性脑损伤 (TBI) 的快速、客观诊断工具有着浓厚的兴趣。 方法 2011-2013 年芬兰图尔库大学医院前瞻性招募患有任何严重程度的 TBI 且有 CT 扫描和骨科损伤控制指征的成年患者 (>= 18)。 TBI的严重程度用GCS分类：GCS 13-15被分类为轻度（mTBI）； GCS 9-12 为中度 (moTBI)，GCS 3-8 为重度 (sTBI)。入院 24 小时内收集血清样本，并使用高性能试剂盒分析生物标志物水平。评估了生物标志物区分 TBI 严重程度以及 CT 阳性和 CT 阴性患者的能力。结果 在招募的 189 名患者中，从 175 名 TBI 患者和 40 名对照患者中获得了神经丝光 (NF-L)。对 184 名 TBI 患者和 39 名对照者的 S100 钙结合蛋白 B (S100B)、心脏脂肪酸结合蛋白 (H-FABP) 和白细胞介素 10 (IL-10) 进行了分析。不同严重程度类别之间所有生物标志物的水平存在统计学显着差异，但没有任何生物标志物能够区分 moTBI 患者和 sTBI 患者。与入住神经外科病房的患者相比，从急诊室出院的 mTBI 患者的 IL--10（0.26，IQR=0.21，0.39 pg/mL）、H-FABP（4.15，IQR=2.72，5.83 ng/mL）和 NF-L（8.6，IQR=6.35，15.98 pg/mL）水平较低。 IL--10 (0.55, IQR=0.31, 1.42 pg/mL)、H-FABP (6.022, IQR=4.19, 20.72 ng/mL) 和 NF-L (13.95, IQR=8.33, 19.93 pg/mL)。我们观察到老年 mTBI 患者的 H-FABP 和 NF-L 水平较高。没有一种生物标志物或其组合能够区分 CT 阳性 (n=36) 或 CT 阴性 (n=58) mTBI 患者与对照。结论 mTBI 患者中 S100B、H-FABP、NF-L 和 IL-10 水平显着低于 moTBI 和 sTBI 患者，但单独或组合无法区分 mTBI 患者与骨科对照。这表明这些生物标志物不能单独用于诊断急性创伤患者的 mTBI。
Background There is substantial interest in blood biomarkers as fast and objective diagnostic tools for traumatic brain injury (TBI) in the acute setting.Methods Adult patients (>= 18) with TBI of any severity and indications for CT scanning and orthopaedic injury controls were prospectively recruited during 2011-2013 at Turku University Hospital, Finland. The severity of TBI was classified with GCS: GCS 13-15 was classified as mild (mTBI); GCS 9-12 as moderate (moTBI) and GCS 3-8 as severe (sTBI). Serum samples were collected within 24 hours of admission and biomarker levels analysed with high-performance kits. The ability of biomarkers to distinguish between severity of TBI and CT-positive and CT-negative patients was assessed.Results Among 189 patients recruited, neurofilament light (NF-L) was obtained from 175 patients with TBI and 40 controls. S100 calcium-binding protein B (S100B), heart fatty-acid binding protein (H-FABP) and interleukin-10 (IL-10) were analysed for 184 patients with TBI and 39 controls. There were statistically significant differences between levels of all biomarkers between the severity classes, but none of the biomarkers distinguished patients with moTBI from patients with sTBI. Patients with mTBI discharged from the ED had lower levels of IL--10 (0.26, IQR=0.21, 0.39 pg/mL), H-FABP (4.15, IQR=2.72, 5.83 ng/mL) and NF-L (8.6, IQR=6.35, 15.98 pg/mL) compared with those admitted to the neurosurgical ward, IL--10 (0.55, IQR=0.31, 1.42 pg/mL), H-FABP (6.022, IQR=4.19, 20.72 ng/mL) and NF-L (13.95, IQR=8.33, 19.93 pg/mL). We observed higher levels of H-FABP and NF-L in older patients with mTBI. None of the biomarkers or their combinations was able to distinguish CT-positive (n=36) or CT-negative (n=58) patients with mTBI from controls.Conclusions S100B, H-FABP, NF-L and IL-10 levels in patients with mTBI were significantly lower than in patients with moTBI and sTBI but alone or in combination, were unable to distinguish patients with mTBI from orthopaedic controls. This suggests these biomarkers cannot be used alone to diagnose mTBI in trauma patients in the acute setting.