Cengiz Pelin, Zemlan Frank, Ellenbogen Richard, Hawkins Douglas, Zimmerman Jerry J
Department of Pediatrics, Pediatric Critical Care Medicine, University of Washington, Seattle, WA, USA.
Pediatr Crit Care Med. 2008 Sep;9(5):524-9. doi: 10.1097/PCC.0b013e3181849dc9.
To ascertain if cerebrospinal fluid cleaved-tau protein and 9-hydroxyoctadecadienoic acid, reflecting potential biomarkers of overall neuronal injury and lipid peroxidation, respectively, are elevated in hydrocephalus patients compared with controls, and if cleaved-tau and 9-hydroxyoctadecadienoic acid levels correlate with each other.
Prospective clinical observational study.
Tertiary-care children's hospital.
Children younger than or equal to 18 yrs who underwent ventriculoperitoneal shunt placement or revision surgery for intrinsic hydrocephalus.
During the study period 12 patients with intrinsic hydrocephalus required ventriculoperitoneal shunt placement or revision. Cerebrospinal fluid cleaved-tau levels were significantly elevated in patients with hydrocephalus (44.7 +/- 9.6 ng/mL, n = 11) compared with control patients (0.0 +/- 0.0 ng/mL, n = 9; p < 0.0001). Cleaved-tau levels correlated with patient age (r = .609, p = 0.047) and duration of symptoms (r = .755, p = 0.007). No significant difference in cerebrospinal fluid 9-hydroxyoctadecadienoic acid levels between patients with hydrocephalus (24.6 +/- 5.7, n = 8) and control patients (24.9 +/- 9.3 ng/mL, n = 7) was detected (p = 0.25). There was also no statistically significant correlation between 9-hydroxyoctadecadienoic acid levels and duration of symptoms (r = .668, p = 0.07), nor was there a significant correlation between 9-hydroxyoctadecadienoic acid levels and patient age (r = -.011, p > 0.10). There was no significant relationship between 9-hydroxyoctadecadienoic acid levels and signs of elevated intracranial pressure, nor was there a correlation between 9-hydroxyoctadecadienoic acid levels and cleaved-tau levels.
Children with hydrocephalus who have clinical signs of increased intracranial pressure and require ventriculoperitoneal shunt placement or revision exhibit markedly elevated cerebrospinal fluid cleaved-tau levels, suggesting evidence of axonal damage. However, this axonal injury does not seem to be associated with significant lipid peroxidation, at least as assessed by quantifying cerebrospinal fluid 9-hydroxyoctadecadienoic acid at a single, concurrent time point. The significant relationship between age and cerebrospinal fluid cleaved-tau levels suggest that brain injury associated with hydrocephalus may be more pronounced in older children.
确定与对照组相比，反映整体神经元损伤和脂质过氧化潜在生物标志物的脑脊液裂解tau蛋白和9-羟基十八碳二烯酸在脑积水患者中是否升高，以及裂解tau蛋白和9-羟基十八碳二烯酸水平是否相互关联。
前瞻性临床观察研究。
三级儿童专科医院。
因原发性脑积水接受脑室腹腔分流术或翻修手术的18岁及以下儿童。
在研究期间，12例原发性脑积水患者需要进行脑室腹腔分流术或翻修。与对照患者（0.0±0.0 ng/mL，n = 9；p < 0.0001）相比，脑积水患者的脑脊液裂解tau蛋白水平显著升高（44.7±9.6 ng/mL，n = 11）。裂解tau蛋白水平与患者年龄（r = 0.609，p = 0.047）和症状持续时间（r = 0.755，p = 0.007）相关。未检测到脑积水患者（24.6±5.7，n = 8）和对照患者（24.9±9.3 ng/mL，n = 7）的脑脊液9-羟基十八碳二烯酸水平有显著差异（p = 0.25）。9-羟基十八碳二烯酸水平与症状持续时间之间也无统计学显著相关性（r = 0.668，p = 0.07），9-羟基十八碳二烯酸水平与患者年龄之间也无显著相关性（r = -0.011，p > 0.10）。9-羟基十八碳二烯酸水平与颅内压升高体征之间无显著关系，9-羟基十八碳二烯酸水平与裂解tau蛋白水平之间也无相关性。
有颅内压升高临床体征且需要进行脑室腹腔分流术或翻修的脑积水儿童，其脑脊液裂解tau蛋白水平显著升高，提示存在轴突损伤证据。然而，这种轴突损伤似乎与显著的脂质过氧化无关，至少在单一同时时间点通过定量脑脊液9-羟基十八碳二烯酸评估时是这样。年龄与脑脊液裂解tau蛋白水平之间的显著关系表明，与脑积水相关的脑损伤在大龄儿童中可能更明显。
