Heller R A, Raven T F, Swing T, Kunzmann K, Daniel V, Haubruck P, Akbar M, Grützner P A, Schmidmaier G, Biglari B, Moghaddam A
Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
Aschaffenburg Trauma and Orthopaedic Research Group, Center for Trauma Surgery, Orthopedics and Sports Medicine Aschaffenburg-Alzenau, Aschaffenburg, Germany.
Spinal Cord. 2017 Nov;55(11):1002-1009. doi: 10.1038/sc.2017.69. Epub 2017 Jun 20.
Prospective observational study.
To describe the correlation between CCL-2, CCL-3, CCL-4 and CXCL-5 serum levels and remission after traumatic spinal cord injury (SCI) in a human protocol compared with animal studies.
Germany, Rhineland-Palatinate (Rheinland-Pfalz).
We examined the serum levels of CCL-2, CCL-3, CCL-4 and CXCL-5 over a 12-week period; in particular, at admission and 4, 9 and 12 h, 1 and 3 days and 1, 2, 4, 8 and 12 weeks after trauma. According to our study design, we matched 10 patients with TSCI and neurological remission with 10 patients with an initial ASIA A grade and no neurological remission. In all, 10 patients with vertebral fracture without neurological deficits served as control. Our analysis was performed using a Luminex Cytokine Panel. Multivariate logistic regression models were used to examine the predictive value with respect to neurological remission vs no neurological remission.
The results of our study showed differences in the serum expression patterns of CCL-2 in association with the neurological remission (CCL-2 at admission P=0.013). Serum levels of CCL-2 and CCL-4 were significantly different in patients with and without neurological remission. The favored predictive model resulted in an area under the curve (AUC) of 93.1% in the receiver operating characteristic (ROC) analysis.
Our results indicate that peripheral serum analysis is a suitable concept for predicting the patient's potential for neurological remission after TSCI. Furthermore, the initial CCL-2 concentration provides an additional predictive value compared with the NLI (neurological level of injury). Therefore, the present study introduces a promising approach for future monitoring concepts and tracking techniques for current therapies. The results indicate that future investigations with an enlarged sample size are needed in order to develop monitoring, prognostic and scoring systems.
前瞻性观察性研究。
在一项人体研究方案中，描述与动物研究相比，创伤性脊髓损伤（SCI）后血清中CCL-2、CCL-3、CCL-4和CXCL-5水平与病情缓解之间的相关性。
德国莱茵兰-普法尔茨州。
我们在12周内检测CCL-2、CCL-3、CCL-4和CXCL-5的血清水平；具体而言，在入院时、创伤后4、9和12小时、1和3天以及1、2、4、8和12周时进行检测。根据我们的研究设计，我们将10例创伤性脊髓损伤且神经功能恢复的患者与10例初始美国脊髓损伤协会（ASIA）A级且无神经功能恢复的患者进行匹配。总共10例无神经功能缺损的椎体骨折患者作为对照。我们使用Luminex细胞因子检测板进行分析。多变量逻辑回归模型用于检验神经功能恢复与无神经功能恢复的预测价值。
我们的研究结果显示，CCL-2的血清表达模式与神经功能恢复存在差异（入院时CCL-2，P=0.013）。有神经功能恢复和无神经功能恢复的患者血清中CCL-2和CCL-4水平存在显著差异。在受试者工作特征（ROC）分析中，最佳预测模型的曲线下面积（AUC）为93.1%。
我们的结果表明，外周血清分析是预测创伤性脊髓损伤后患者神经功能恢复潜力的合适方法。此外，与神经损伤水平（NLI）相比，初始CCL-2浓度具有额外的预测价值。因此，本研究为未来的监测概念和当前治疗的跟踪技术引入了一种有前景的方法。结果表明，为了开发监测、预后和评分系统，未来需要进行更大样本量的研究。
