颅脑创伤患者脑脊液中半胱氨酸天冬氨酸蛋白酶-1 水平：与颅内压和预后的相关性。
Levels of caspase-1 in cerebrospinal fluid of patients with traumatic brain injury: correlation with intracranial pressure and outcome.
机构信息
1Intensive Care Department.
2Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), and.
出版信息
J Neurosurg. 2020 May 1;134(5):1644-1649. doi: 10.3171/2020.2.JNS193079. Print 2021 May 1.
OBJECTIVE
The objectives of this study were to evaluate levels of inflammasome-signaling proteins in serum and CSF of patients with traumatic brain injury (TBI), and to correlate these protein levels with intracranial pressure (ICP) and clinical outcomes at 6 months after injury.
METHODS
This is a prospective and observational study in patients with moderate and severe TBI who required an external ventricular drain as part of their treatment. Serum and CSF samples were collected 3 times a day for the first 5 days after TBI. The authors have determined the protein concentration of caspase-1 in the CSF and serum of patients with TBI by using commercially available enzyme-linked immunosorbent assays. The ICP value was recorded hourly. The 6-month outcome was assessed using the Glasgow Outcome Scale-Extended.
RESULTS
A total of 21 patients were included in this study, and a total of 234 paired serum-CSF samples were analyzed. The area under the curve (AUC) value of caspase-1 in CSF during the 5-day period was 2452.9 pg/mL·hr in the group of patients with high ICP vs 617.6 pg/mL·hr in the patients with low ICP. The differences were mainly on day 2 (19.7 pg/mL vs 1.8 pg/mL; p = 0.06) and day 3 (13.9 pg/mL vs 1 pg/mL; p = 0.05). The AUC value of caspase in CSF during the 5-day period was 1918.9 pg/mL·hr in the group of patients with poor outcome versus 924.5 pg/mL·hr in the patients with good outcome. The protein levels of caspase-1 in CSF were higher in patients with unfavorable outcomes during the first 96 hours after TBI.
CONCLUSIONS
In this cohort of patients with TBI who were admitted to the neurosurgical ICU, the inflammasome protein caspase-1 is increased in the CSF of patients with high ICP, especially on days 2 and 3 after TBI. Also the protein levels of caspase-1 in CSF were higher in patients with poor outcome during the first 96 hours after TBI. Moreover, not only the absolute value of caspase-1 in CSF but also its trend is associated with poor outcomes.
目的
本研究旨在评估创伤性脑损伤（TBI）患者血清和脑脊液中炎症小体信号蛋白的水平，并将这些蛋白水平与伤后 6 个月的颅内压（ICP）和临床结果相关联。
方法
这是一项对需要外部脑室引流作为治疗一部分的中重度 TBI 患者进行的前瞻性、观察性研究。TBI 后第 1 天至第 5 天，每天采集 3 次血清和脑脊液样本。作者通过商业酶联免疫吸附测定法测定了 TBI 患者脑脊液和血清中半胱氨酸蛋白酶-1 的蛋白浓度。每小时记录 ICP 值。使用格拉斯哥预后评分扩展版评估 6 个月的预后。
结果
本研究共纳入 21 例患者，共分析了 234 对血清-脑脊液样本。ICP 较高组患者 5 天内脑脊液中 caspase-1 的曲线下面积（AUC）值为 2452.9 pg/mL·hr，ICP 较低组为 617.6 pg/mL·hr。差异主要发生在第 2 天（19.7 pg/mL 比 1.8 pg/mL；p = 0.06）和第 3 天（13.9 pg/mL 比 1 pg/mL；p = 0.05）。5 天内脑脊液中 caspase 的 AUC 值在预后不良组为 1918.9 pg/mL·hr，在预后良好组为 924.5 pg/mL·hr。TBI 后前 96 小时，预后不良患者脑脊液中 caspase-1 蛋白水平升高。
结论
在本队列中，入住神经外科重症监护病房的 TBI 患者，ICP 较高患者的脑脊液中炎症小体蛋白 caspase-1 增加，尤其是 TBI 后第 2 天和第 3 天。而且，TBI 后前 96 小时，预后不良患者脑脊液中 caspase-1 蛋白水平更高。此外，不仅 CSF 中 caspase-1 的绝对值，其趋势也与不良预后相关。
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