United BioSource Corporation, Lexington, MA 0242, USA.
Mol Diagn Ther. 2012 Apr 1;16(2):79-92. doi: 10.2165/11631580-000000000-00000.
Traumatic brain injuries (TBIs) are potentially lethal medical conditions, with symptoms that can overlap with symptoms of injuries outside the brain. In many cases, current diagnostic methods do not fully distinguish acute brain injury from other organ damage. In the management of stroke patients, the choice of treatment depends on whether the stroke is ischemic or hemorrhagic; however, no quick lab diagnostic tests are available to distinguish between the two types of strokes. As a result, patient triage, disposition, and patient management decisions may be delayed for patients with suspected TBI and stroke. Glial fibrillary acidic protein (GFAP), a brain-specific biomarker that is released into the blood following TBI and stroke, is being explored for potential diagnostic and prognostic value in these indications. We therefore conducted a review of MEDLINE-indexed publications from 2004 to 2011 to evaluate the current status of GFAP as a prognostic and diagnostic tool for TBI and stroke within the context of current published guidelines. Our review suggests that GFAP could provide clinically valuable information for the prognosis of TBI and stroke, but it is still at an early stage of development as a biomarker. Several TBI studies have shown elevated GFAP levels following a TBI event to be associated with greater severity of injury, poorer outcomes, and increased mortality. Clinical studies also indicate that GFAP has potential clinical utility in the differential diagnosis of various types of stroke. However, more clinical research will be required to determine the ability of GFAP levels to diagnose TBI in heterogeneous patient populations, as well as the ability of GFAP to differentiate between ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and non-stroke conditions in populations of patients with suspected rather than confirmed stroke. Additional clinical studies will also be required to define the temporal patterns of GFAP release in IS, ICH, SAH, and TBI, and their potential use in the differential diagnosis of these conditions. Finally, such research could demonstrate the ability of GFAP test results to provide unique clinical information that informs management decisions for TBI and stroke patients.
创伤性脑损伤（TBI）是一种潜在致命的医疗状况，其症状可能与脑外损伤的症状重叠。在许多情况下，目前的诊断方法不能完全区分急性脑损伤和其他器官损伤。在中风患者的管理中，治疗的选择取决于中风是缺血性还是出血性；然而，目前没有快速的实验室诊断测试来区分这两种类型的中风。因此，对于疑似 TBI 和中风的患者，患者分诊、处置和患者管理决策可能会被延迟。胶质纤维酸性蛋白（GFAP）是一种脑特异性生物标志物，在 TBI 和中风后会释放到血液中，目前正在探索其在这些适应症中的潜在诊断和预后价值。因此，我们对 2004 年至 2011 年期间 MEDLINE 索引出版物进行了综述，以评估 GFAP 在当前发表的指南背景下作为 TBI 和中风预后和诊断工具的现状。我们的综述表明，GFAP 可能为 TBI 和中风的预后提供有临床价值的信息，但作为一种生物标志物，它仍处于早期发展阶段。几项 TBI 研究表明，TBI 事件后 GFAP 水平升高与损伤严重程度增加、预后不良和死亡率增加相关。临床研究还表明，GFAP 在各种类型中风的鉴别诊断中具有潜在的临床应用价值。然而，需要更多的临床研究来确定 GFAP 水平在异质患者人群中诊断 TBI 的能力，以及 GFAP 区分缺血性中风（IS）、脑出血（ICH）、蛛网膜下腔出血（SAH）和非中风患者的能力。还需要进行更多的临床研究来确定 GFAP 在 IS、ICH、SAH 和 TBI 中的释放时间模式，及其在这些疾病的鉴别诊断中的潜在用途。最后，此类研究可以证明 GFAP 测试结果能够提供独特的临床信息，为 TBI 和中风患者的管理决策提供信息。
