血清泛素羧基末端水解酶水平可区分轻度创伤性脑损伤与创伤对照，且颅内病变和神经外科干预的轻、中度创伤性脑损伤患者的血清泛素羧基末端水解酶水平升高。
Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention.
机构信息
Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida 32806, USA.
出版信息
J Trauma Acute Care Surg. 2012 May;72(5):1335-44. doi: 10.1097/TA.0b013e3182491e3d.
BACKGROUND
This study compared early serum levels of ubiquitin C-terminal hydrolase (UCH-L1) from patients with mild and moderate traumatic brain injury (TBI) with uninjured and injured controls and examined their association with traumatic intracranial lesions on computed tomography (CT) scan (CT positive) and the need for neurosurgical intervention (NSI).
METHODS
This prospective cohort study enrolled adult patients presenting to three tertiary care Level I trauma centers after blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale (GCS) score 9 to 15. Control groups included normal uninjured controls and nonhead injured trauma controls presenting to the emergency department with orthopedic injuries or motor vehicle crash without TBI. Blood samples were obtained in all trauma patients within 4 hours of injury and measured by enzyme-linked immunosorbent assay for UCH-L1 (ng/mL ± standard error of the mean).
RESULTS
There were 295 patients enrolled, 96 TBI patients (86 with GCS score 13-15 and 10 with GCS score 9-12), and 199 controls (176 uninjured, 16 motor vehicle crash controls, and 7 orthopedic controls). The AUC for distinguishing TBI from uninjured controls was 0.87 (95% confidence interval [CI], 0.82-0.92) and for distinguishing those TBIs with GCS score 15 from controls was AUC 0.87 (95% CI, 0.81-0.93). Mean UCH-L1 levels in patients with CT negative versus CT positive were 0.620 (± 0.254) and 1.618 (± 0.474), respectively (p < 0.001), and the AUC was 0.73 (95% CI, 0.62-0.84). For patients without and with NSI, levels were 0.627 (0.218) versus 2.568 (0.854; p < 0.001), and the AUC was 0.85 (95% CI, 0.76-0.94).
CONCLUSION
UCH-L1 is detectable in serum within an hour of injury and is associated with measures of injury severity including the GCS score, CT lesions, and NSI. Further study is required to validate these findings before clinical application.
LEVEL OF EVIDENCE
II, prognostic study.
背景
本研究比较了轻度和中度创伤性脑损伤（TBI）患者与未受伤和受伤对照者的早期血清泛素羧基末端水解酶（UCH-L1）水平，并探讨了其与 CT 扫描上创伤性颅内病变（CT 阳性）和神经外科干预（NSI）需求的关系。
方法
这项前瞻性队列研究纳入了在 3 家三级甲等创伤中心因钝性头部外伤而导致意识丧失、遗忘或定向障碍且格拉斯哥昏迷量表（GCS）评分为 9 至 15 分的成年患者。对照组包括正常未受伤的对照者和因骨科损伤或机动车碰撞而就诊于急诊但无 TBI 的非头部受伤的创伤对照者。所有创伤患者均在受伤后 4 小时内采集血液样本，并通过酶联免疫吸附试验测量 UCH-L1（ng/mL±均数标准差）。
结果
共纳入 295 例患者，其中 96 例 TBI 患者（86 例 GCS 评分 13-15 分，10 例 GCS 评分 9-12 分），199 例对照者（176 例未受伤，16 例机动车碰撞对照者，7 例骨科对照者）。UCH-L1 区分 TBI 与未受伤对照者的 AUC 为 0.87（95%置信区间 [CI]，0.82-0.92），区分 GCS 评分 15 分的 TBI 与对照者的 AUC 为 0.87（95% CI，0.81-0.93）。CT 阴性与 CT 阳性患者的 UCH-L1 平均水平分别为 0.620（±0.254）和 1.618（±0.474）（p＜0.001），AUC 为 0.73（95% CI，0.62-0.84）。无 NSI 和有 NSI 患者的水平分别为 0.627（0.218）和 2.568（0.854；p＜0.001），AUC 为 0.85（95% CI，0.76-0.94）。
结论
UCH-L1 在受伤后 1 小时内即可在血清中检测到，与包括 GCS 评分、CT 病变和 NSI 在内的损伤严重程度指标相关。在临床应用之前，还需要进一步研究来验证这些发现。
证据等级
II，预后研究。
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