新功能、新界面、新体验,扫描即可下载生物谷APP!
首页 » EOMD:生物标记物有助于创伤性脑损伤患者分层

EOMD:生物标记物有助于创伤性脑损伤患者分层

来源:elseviermed 2011-07-01 13:28

据急诊医学学会年会上公布的一项对急诊科头部损伤患者的前瞻性队列研究,生物标记物胶质纤维酸性蛋白(GFAP)可准确区分轻度与中度创伤性脑损伤,轻度创伤性脑损伤与对照,以及CT显示有与无颅内病变的患者。

GFAP是在胶质神经细胞中被发现的,具有中枢神经系统特异性,在灰质和白质中均有分布,近期发现可在血清中检出,这使其成为一种颇具吸引力的备选临床生物标记物。目前,Glasgow昏迷量表(GCS)是评估头部损伤患者的主要指标,但这种方法可能受到麻醉剂、治疗药物、其他损伤或低灌注的影响,并且它其实并不是专为急诊室开发的。为了探索可以快速、准确检测脑损伤的生物标记物,奥兰多卫生医学教育研究生院临床研究学院主管兼奥兰多(佛罗里达州)地区医学中心急诊科主治医师Linda Papa及其同事进行了这项研究。

该研究纳入了在3个一级创伤中心因轻度或中度闭合创伤性脑损伤(TBI)和意识消失或感觉变化而就诊的成人患者。患者在急诊室募集,并在损伤后4 h内采集血样。所有患者接受CT扫描。对照组纳入整形外科创伤或机动车创伤不伴头部损伤的患者以及正常健康人群。

研究中共纳入307例患者,其中108例有TBI。TBI患者平均年龄为39岁(范围18~89岁),其中65%为男性。共97例患者GCS评分为13~15(轻度),11例GCS评分为9~12(中度)。在97例GCS 13~15分的患者中,24例(25%)CT扫描显示有颅内病变,在11例GCS 9~12分的患者中,8例(73%) CT扫描显示有颅内病变。对照组包括176例正常个体、16例无头部损伤的机动车事故受伤患者和7例整形外科损伤患者。

结果显示,平均于损伤后2.7h采集血样。GFAP生物标记物于1h内出现在血清中(在较早采集血样的患者中),3~4 h内达到高峰,然后水平降低。早期GFAP水平可以曲线下面积(AUC) 0.90(1.0是最好的状态)区分TBI与无损伤对照,以AUC 0.88区分轻度TBI(GCS 15)与所有对照。CT扫描阴性和阳性患者的平均GFAP水平分别为0.335 ng/ml和 2.168 ng/ml,具有高度统计学差异,可以AUC 0.79区分。

这一发现提示早期评估GFAP可作为潜在有价值的临床工具,确定是否对麻醉或镇静患者进行影像学检查,区分应收入院或出院的急诊科患者,评估多种创伤患者的脑损伤严重程度,确定是否需寻求神经外科咨询和(或)转入神经外科,并评估患者能否重返工作岗位。(生物谷Bioon.com)

生物谷推荐原文出处:

Expert Opinion on Medical Diagnostics    doi:10.1517/17530059.2.8.937

Use of biomarkers for diagnosis and management of traumatic brain injury patients

Linda Papa, Gillian Robinson, Monika Oli, Jose Pineda, Jason Demery, Gretchen Brophy, Steve A Robicsek, Andrea Gabrielli, Claudia S Robertson, Kevin K Wang and Ronald L Hayes

Background: Advances in the understanding of human biochemistry and physiology have provided insight into new pathways by which we can understand traumatic brain injury (TBI). Increased sophistication of laboratory techniques and developments in the field of proteomics has led to the discovery and rapid detection of new biomarkers not previously available. Objective: To review recent advances in biomarker research for traumatic brain injury, describe the features of the ideal biomarker and to explore the potential role of these biomarkers in improving clinical management of brain injured patients. Methods: Through a literature review of recent research on TBI biomarkers and through experience with TBI research, important elements of biomarker development are described together with potential applications to patient care. Conclusions: TBI biomarkers could have a significant impact on patient care by assisting in the diagnosis, risk stratification and management of TBI. Biomarkers could provide major opportunities for the conduct of clinical research, including confirmation of injury mechanism(s) and drug target identification. Continuing studies by the authors' group are now being conducted to elucidate more fully the relationships between new biomarkers and severity of injury and clinical outcomes in all severities of TBI patients.

温馨提示:87%用户都在生物谷APP上阅读,扫描立刻下载! 天天精彩!


相关标签

最新会议 培训班 期刊库