Department of Anesthesiology and Critical Care, Johns Hopkins University, Baltimore, MD, USA. mbembea1jhmi.edu
Pediatr Crit Care Med. 2011 Sep;12(5):572-9. doi: 10.1097/PCC.0b013e3181fe3ec7.
To determine whether, in children, plasma glial fibrillary acidic protein is associated with brain injury during extracorporeal membrane oxygenation and with mortality.
Prospective, observational study.
Pediatric intensive care unit in an urban tertiary care academic center.
Neonatal and pediatric patients on extracorporeal membrane oxygenation (n = 22).
Serial blood sampling for glial fibrillary acidic protein measurements.
Prospective patients age 1 day to 18 yrs who required extracorporeal membrane oxygenation from April 2008 to August 2009 were studied. Glial fibrillary acidic protein was measured using an electrochemiluminescent immunoassay developed at Johns Hopkins. Control samples were collected from 99 healthy children (0.5-16 yrs) and 59 neonatal intensive care unit infants without neurologic injury. In controls, the median glial fibrillary acidic protein concentration was 0.055 ng/mL (interquartile range, 0-0.092 ng/mL) and the 95th percentile of glial fibrillary acidic protein was 0.436 ng/mL. In patients on extracorporeal membrane oxygenation, plasma glial fibrillary acidic protein was measured at 6, 12, and every 24 hrs after cannulation. We enrolled 22 children who underwent extracorporeal membrane oxygenation. Median age was 7 days (interquartile range, 2 days to 9 yrs), and primary extracorporeal membrane oxygenation indication was: cardiac failure, six of 22 (27.3%); respiratory failure, 12 of 22 (54.5%); extracorporeal cardiopulmonary resuscitation, three of 22 (13.6%); and sepsis, one of 22 (4.6%). Seven of 22 (32%) patients developed acute neurologic injury (intracranial hemorrhage, brain death, or cerebral edema diagnosed by imaging). Fifteen of 22 (68%) survived to hospital discharge. In the extracorporeal membrane oxygenation group, peak glial fibrillary acidic protein levels were higher in children with brain injury than those without (median, 5.9 vs. 0.09 ng/mL, p = .04) and in nonsurvivors compared with survivors to discharge (median, 5.9 vs. 0.09 ng/mL, p = .04). The odds ratio for brain injury for glial fibrillary acidic protein >0.436 ng/mL vs. normal was 11.5 (95% confidence interval, 1.3-98.3) and the odds ratio for mortality was 13.6 (95% confidence interval, 1.7-108.5).
High glial fibrillary acidic protein during extracorporeal membrane oxygenation is significantly associated with acute brain injury and death. Brain injury biomarkers may aid in outcome prediction and neurologic monitoring of patients on extracorporeal membrane oxygenation to improve outcomes and benchmark new therapies.
在体外膜肺氧合期间，确定儿童血浆神经胶质纤维酸性蛋白是否与脑损伤有关，以及是否与死亡率有关。
前瞻性观察性研究。
城市三级学术中心的儿科重症监护病房。
需要体外膜肺氧合的新生儿和儿科患者（n=22）。
连续采血进行神经胶质纤维酸性蛋白测量。
2008 年 4 月至 2009 年 8 月期间，对需要体外膜肺氧合的 1 天至 18 岁的患者进行了前瞻性研究。使用约翰霍普金斯大学开发的电化学发光免疫测定法测量神经胶质纤维酸性蛋白。对照组采集了 99 名健康儿童（0.5-16 岁）和 59 名无神经损伤的新生儿重症监护病房婴儿的对照样本。在对照组中，神经胶质纤维酸性蛋白的中位数浓度为 0.055ng/ml（四分位间距，0-0.092ng/ml），神经胶质纤维酸性蛋白的第 95 百分位数为 0.436ng/ml。在接受体外膜肺氧合的患者中，在插管后 6、12 和每 24 小时测量血浆神经胶质纤维酸性蛋白。我们纳入了 22 名接受体外膜肺氧合的患者。中位年龄为 7 天（四分位间距，2 天至 9 岁），体外膜肺氧合的主要指征是：心力衰竭，22 例中的 6 例（27.3%）；呼吸衰竭，22 例中的 12 例（54.5%）；体外心肺复苏，22 例中的 3 例（13.6%）；败血症，22 例中的 1 例（4.6%）。22 例患者中的 7 例（32%）发生急性神经损伤（通过影像学诊断颅内出血、脑死亡或脑水肿）。22 例患者中有 15 例（68%）存活至出院。在体外膜肺氧合组中，有脑损伤的患儿的神经胶质纤维酸性蛋白峰值水平高于无脑损伤的患儿（中位数分别为 5.9ng/ml 和 0.09ng/ml，p=0.04），且幸存者的神经胶质纤维酸性蛋白峰值水平高于非幸存者（中位数分别为 5.9ng/ml 和 0.09ng/ml，p=0.04）。神经胶质纤维酸性蛋白水平＞0.436ng/ml 的患儿发生脑损伤的比值比为 11.5（95%置信区间，1.3-98.3），死亡率的比值比为 13.6（95%置信区间，1.7-108.5）。
体外膜肺氧合期间神经胶质纤维酸性蛋白升高与急性脑损伤和死亡显著相关。脑损伤生物标志物可能有助于预测体外膜肺氧合患者的预后和神经监测，以改善预后并为新疗法提供基准。
