Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
Neurocrit Care. 2012 Dec;17(3):401-7. doi: 10.1007/s12028-012-9767-0.
The objectives of this study were to determine effects of severe traumatic brain injury (TBI) on cerebrospinal fluid (CSF) concentrations of myelin basic protein (MBP) and to assess relationships between clinical variables and CSF MBP concentrations.
We measured serial CSF MBP concentrations in children enrolled in a randomized controlled trial evaluating therapeutic hypothermia (TH) after severe pediatric TBI. Control CSF was obtained from children evaluated, but found not to be having CNS infection. Generalized estimating equation models and Wilcoxon Rank-Sum test were used for comparisons of MBP concentrations.
There were 27 TBI cases and 57 controls. Overall mean (± SEM) TBI case MBP concentrations for 5 days after injury were markedly greater than controls (50.49 ± 6.97 vs. 0.11 ± 0.01 ng/ml, p < 0.01). Mean MBP concentrations were lower in TBI patients <1 year versus >1 year (9.18 ± 1.67 vs. 60.22 ± 8.26 ng/ml, p = 0.03), as well as in cases with abusive head trauma (AHT) versus non-abusive TBI (14.46 ± 3.15 vs. 61.17 ± 8.65 ng/ml, p = 0.03). TH did not affect MBP concentrations.
Mean CSF MBP increases markedly after severe pediatric TBI, but is not affected by TH. Infancy and AHT are associated with low MBP concentrations, suggesting that age-dependent myelination influences MBP concentrations after injury. Given the magnitude of MBP increases, axonal injury likely represents an important therapeutic target in pediatric TBI.
本研究旨在确定严重创伤性脑损伤（TBI）对脑脊液（CSF）髓鞘碱性蛋白（MBP）浓度的影响，并评估临床变量与 CSF MBP 浓度之间的关系。
我们测量了入组评估治疗性低温（TH）治疗严重儿科 TBI 的随机对照试验的儿童的连续 CSF MBP 浓度。对照 CSF 取自经评估但未发生中枢神经系统感染的儿童。使用广义估计方程模型和 Wilcoxon 秩和检验比较 MBP 浓度。
共有 27 例 TBI 病例和 57 例对照。损伤后 5 天的总体 TBI 病例 MBP 浓度明显高于对照组（50.49 ± 6.97 与 0.11 ± 0.01ng/ml，p < 0.01）。<1 岁的 TBI 患者的平均 MBP 浓度低于>1 岁的患者（9.18 ± 1.67 与 60.22 ± 8.26ng/ml，p = 0.03），虐待性头部外伤（AHT）病例的 MBP 浓度也低于非虐待性 TBI 病例（14.46 ± 3.15 与 61.17 ± 8.65ng/ml，p = 0.03）。TH 不影响 MBP 浓度。
严重儿科 TBI 后 CSF MBP 平均浓度显著增加，但不受 TH 影响。婴儿期和 AHT 与低 MBP 浓度相关，表明年龄依赖性髓鞘形成影响损伤后 MBP 浓度。鉴于 MBP 增加的幅度，轴突损伤可能是儿科 TBI 的一个重要治疗靶点。
