Department of Neurobiology and Anatomy, The University of Texas Medical School, Houston, TX 77225, USA.
J Neurosci Res. 2010 Jun;88(8):1719-26. doi: 10.1002/jnr.22336.
High intracranial pressure (ICP) is a prominent secondary pathology after traumatic brain injury (TBI) and is a major contributor to morbidity and mortality. Currently, there are no clinically proven methods for predicting which TBI patients will develop high ICP. In the present study, we examined whether the serum levels of the copper-binding protein ceruloplasmin are differentially altered in patients with elevated ICP (> or =25 mmHg) vs. those whose ICP remained below 20 mmHg throughout the study period. Consistent with its role as an acute-phase reactant, we found that ceruloplasmin levels were significantly increased by 3 days post-TBI compared with healthy volunteers. However, prior to this delayed increase, ceruloplasmin levels during the first 24 hr following injury were found to be significantly reduced in patients who subsequently developed high ICP. This decrease was found to have prognostic accuracy in delineating TBI patients based on their ICP status (cutoff of 140 microg/ml; sensitivity: 87%, specificity: 73%), Likewise, low total serum copper (below 1.32 microg/ml) was also found to be predictive of high ICP (sensitivity 86%, specificity 73%). These results suggest that initial serum ceruloplasmin/copper levels may have diagnostic value in predicting patients at risk for developing high intracranial pressure.
颅内压升高（ICP）是颅脑损伤（TBI）后的一种突出的继发性病变，是发病率和死亡率的主要原因。目前，尚无经临床证实的方法可预测哪些 TBI 患者会出现高 ICP。在本研究中，我们检测了铜结合蛋白铜蓝蛋白的血清水平是否在 ICP 升高（≥25mmHg）的患者与整个研究期间 ICP 保持在 20mmHg 以下的患者之间存在差异。与它作为急性期反应物的作用一致，我们发现铜蓝蛋白水平在 TBI 后 3 天与健康志愿者相比显著升高。然而，在这种延迟增加之前，我们发现随后发生高 ICP 的患者在损伤后 24 小时内的铜蓝蛋白水平显著降低。根据 ICP 状态，这种降低在区分 TBI 患者方面具有预后准确性（临界值为 140μg/ml；敏感性：87%，特异性：73%）。同样，总血清铜含量低（低于 1.32μg/ml）也被发现可预测高 ICP（敏感性 86%，特异性 73%）。这些结果表明，初始血清铜蓝蛋白/铜水平可能具有预测发生高颅内压风险的患者的诊断价值。
