Departments of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Neurology. 2010 Nov 16;75(20):1786-93. doi: 10.1212/WNL.0b013e3181fd62d2.
Biomarker levels in blood after traumatic brain injury (TBI) may offer diagnostic and prognostic tools in addition to clinical indices. This study aims to validate glial fibrillary acidic protein (GFAP) and S100B concentrations in blood as outcome predictors of TBI using cutoff levels of 1.5 μg/L for GFAP and 1.13 μg/L for S100B from a previous study.
In 79 patients with TBI (Glasgow Coma Scale score [GCS] ≤12), serum, taken at hospital admission, was analyzed for GFAP and S100B. Data collected included injury mechanism, age, gender, mass lesion on CT, GCS, pupillary reactions, Injury Severity Score (ISS), presence of hypoxia, and hypotension. Outcome was assessed, using the Glasgow Outcome Scale Extended (dichotomized in death vs alive and unfavorable vs favorable), 6 months post injury.
In patients who died compared to alive patients, median serum levels were increased: GFAP 33.4-fold and S100B 2.1-fold. In unfavorable compared to favorable outcome, GFAP was increased 19.8-fold and S100B 2.1-fold. Univariate logistic regression analysis revealed that mass lesion, GFAP, absent pupils, age, and ISS, but not GCS, hypotension, or hypoxia, predicted death and unfavorable outcome. Multivariable analysis showed that models containing mass lesion, pupils, GFAP, and S100B were the strongest in predicting death and unfavorable outcome. S100B was the strongest single predictor of unfavorable outcome with 100% discrimination.
This study confirms that GFAP and S100B levels in serum are adjuncts to the assessment of brain damage after TBI and may enhance prognostication when combined with clinical variables.
创伤性脑损伤（TBI）后血液中的生物标志物水平除了临床指标外，还可能提供诊断和预后工具。本研究旨在使用先前研究中确定的 GFAP 为 1.5μg/L 和 S100B 为 1.13μg/L 的截断值，验证血液中 GFAP 和 S100B 浓度作为 TBI 结局的预测因子。
在 79 例 TBI 患者（格拉斯哥昏迷量表评分[GCS]≤12）中，入院时采集血清，分析 GFAP 和 S100B。收集的数据包括损伤机制、年龄、性别、CT 上的肿块、GCS、瞳孔反应、损伤严重程度评分（ISS）、缺氧和低血压的存在。使用损伤后 6 个月的格拉斯哥预后扩展量表（死亡与存活和不良与良好之间进行二分法）评估结局。
与存活患者相比，死亡患者的血清中位水平升高：GFAP 升高 33.4 倍，S100B 升高 2.1 倍。与不良结局相比，GFAP 升高 19.8 倍，S100B 升高 2.1 倍。单变量逻辑回归分析显示，肿块、GFAP、无瞳孔、年龄和 ISS，但不是 GCS、低血压或缺氧，可预测死亡和不良结局。多变量分析表明，包含肿块、瞳孔、GFAP 和 S100B 的模型在预测死亡和不良结局方面最强。S100B 是不良结局的最强单项预测因子，具有 100%的鉴别力。
本研究证实，血清中 GFAP 和 S100B 水平是 TBI 后脑损伤评估的辅助手段，与临床变量结合使用可能会增强预后判断。
