Sharma Richa, Rosenberg Alexandra, Bennett Ellen R, Laskowitz Daniel T, Acheson Shawn K
School of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
Department of Neurology, Duke University Medical Center, Durham, North Carolina, United States of America.
PLoS One. 2017 Mar 29;12(3):e0173798. doi: 10.1371/journal.pone.0173798. eCollection 2017.
Mild traumatic brain injury (TBI) accounts for the vast majority of the nearly two million brain injuries suffered in the United States each year. Mild TBI is commonly classified as complicated (radiographic evidence of intracranial injury) or uncomplicated (radiographically negative). Such a distinction is important because it helps to determine the need for further neuroimaging, potential admission, or neurosurgical intervention. Unfortunately, imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are costly and not without some risk. The purpose of this study was to screen 87 serum biomarkers to identify a select panel of biomarkers that would predict the presence of intracranial injury as determined by initial brain CT. Serum was collected from 110 patients who sustained a mild TBI within 24 hours of blood draw. Two models were created. In the broad inclusive model, 72kDa type IV collagenase (MMP-2), C-reactive protein (CRP), creatine kinase B type (CKBB), fatty acid binding protein-heart (hFABP), granulocyte-macrophage colony-stimulating factor (GM-CSF) and malondialdehyde modified low density lipoprotein (MDA-LDL) significantly predicted injury visualized on CT, yielding an overall c-statistic of 0.975 and a negative predictive value (NPV) of 98.6. In the parsimonious model, MMP-2, CRP, and CKBB type significantly predicted injury visualized on CT, yielding an overall c-statistic of 0.964 and a negative predictive value (NPV) of 97.2. These results suggest that a serum based biomarker panel can accurately differentiate patients with complicated mild TBI from those with uncomplicated mild TBI. Such a panel could be useful to guide early triage decisions, including the need for further evaluation or admission, especially in those environments in which resources are limited.
轻度创伤性脑损伤（TBI）占美国每年近200万例脑损伤的绝大多数。轻度TBI通常分为复杂型（颅内损伤的影像学证据）或非复杂型（影像学检查阴性）。这种区分很重要，因为它有助于确定是否需要进一步的神经影像学检查、潜在的住院治疗或神经外科干预。不幸的是，诸如计算机断层扫描（CT）和磁共振成像（MRI）等成像方式成本高昂且并非没有风险。本研究的目的是筛选87种血清生物标志物，以确定一组能够预测初始脑部CT所确定的颅内损伤存在的生物标志物。在采血后24小时内，从110例轻度TBI患者中采集血清。创建了两个模型。在广泛纳入模型中，72kDa IV型胶原酶（MMP-2）、C反应蛋白（CRP）、肌酸激酶B型（CKBB）、心脏脂肪酸结合蛋白（hFABP）、粒细胞-巨噬细胞集落刺激因子（GM-CSF）和丙二醛修饰的低密度脂蛋白（MDA-LDL）显著预测了CT上显示的损伤，总体c统计值为0.975，阴性预测值（NPV）为98.6。在简约模型中，MMP-2、CRP和CKBB型显著预测了CT上显示的损伤，总体c统计值为0.964，阴性预测值（NPV）为97.2。这些结果表明，基于血清的生物标志物组可以准确区分复杂型轻度TBI患者和非复杂型轻度TBI患者。这样的生物标志物组可用于指导早期分诊决策，包括是否需要进一步评估或住院治疗，特别是在资源有限的环境中。
