Guéz Michel, Hildingsson Christer, Rosengren Lars, Karlsson Kurt, Toolanen Göran
Department of Ortopaedics, Umeå University Hospital, 90185 Umeå, Sweden.
J Neurotrauma. 2003 Sep;20(9):853-8. doi: 10.1089/089771503322385782.
Clinical examination is the only tool available to assess the extent of the nerve tissue damage after a spinal cord injury, and it is well known that the reliability of classification based on clinical examination is not satisfactory, especially in cases with incomplete motor injuries. There is a need to evaluate new methods in order to improve the possibilities of classifying and prognosticating spinal cord injuries. Methods for assessing central nervous system (CNS) damage using markers in cerebrospinal fluid (CSF) have recently been developed. Previous studies have reported glial fibrillary acidic protein (GFAp) and neurofilament protein (NFL) levels in non-traumatic diseases in the central nervous system. The present study is the first report of GFAp and NFL levels in CSF after trauma to the cervical spine. Six cases with cord damage and pronounced neurological deficit showed significantly increased concentrations of both GFAp and NFL in the CSF. Patients with tetrapareses showed higher values than those with incomplete injuries. Three of the 17 whiplash cases had increased levels of NFL, but normal GFAp. Assessment of nervous tissue markers in CSF will probably improve possibilities to classify and prognosticate spinal cord injuries and also to evaluate pharmacological intervention. The increased levels of NFL in three whiplash cases indicate neural damage in a proportion of the cases with neurological deficit. Neurological examinations are presently the only tools for grading and prognostication of spinal cord injuries. Assessment of nervous tissue markers in CSF makes it possible to quantify the degree of nerve cell damage after different types of cervical spine injury ranging from spinal cord lesions to whiplash injuries.
临床检查是评估脊髓损伤后神经组织损伤程度的唯一可用工具，众所周知，基于临床检查的分类可靠性并不令人满意，尤其是在不完全运动损伤的情况下。需要评估新的方法，以提高脊髓损伤分类和预后评估的可能性。最近已开发出使用脑脊液（CSF）中的标志物评估中枢神经系统（CNS）损伤的方法。先前的研究报道了中枢神经系统非创伤性疾病中胶质纤维酸性蛋白（GFAp）和神经丝蛋白（NFL）的水平。本研究是首次报道颈椎外伤后脑脊液中GFAp和NFL的水平。6例脊髓损伤且有明显神经功能缺损的患者脑脊液中GFAp和NFL浓度均显著升高。四肢瘫患者的值高于不完全损伤患者。17例挥鞭样损伤病例中有3例NFL水平升高，但GFAp正常。评估脑脊液中的神经组织标志物可能会提高脊髓损伤分类和预后评估的可能性，也有助于评估药物干预效果。3例挥鞭样损伤病例中NFL水平升高表明部分有神经功能缺损的病例存在神经损伤。目前神经学检查是脊髓损伤分级和预后评估的唯一工具。评估脑脊液中的神经组织标志物能够量化从脊髓损伤到挥鞭样损伤等不同类型颈椎损伤后神经细胞损伤的程度。
