Edwards Katie A, Pattinson Cassandra L, Guedes Vivian A, Peyer Jordan, Moore Candace, Davis Tara, Devoto Christina, Turtzo L Christine, Latour Lawrence, Gill Jessica M
National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States.
Front Neurol. 2020 May 19;11:348. doi: 10.3389/fneur.2020.00348. eCollection 2020.
Elevated levels of blood-based proinflammatory cytokines are linked to acute moderate to severe traumatic brain injuries (TBIs), yet less is known in acute mild (m)TBI cohorts. The current study examined whether blood-based cytokines can differentiate patients with mTBI, with and without neuroimaging findings (CT and MRI). Within 24 h of a mTBI, determined by a Glasgow Coma Scale (GCS) between 13 and 15, participants ( = 250) underwent a computed tomography (CT) and magnetic resonance imaging (MRI) scan and provided a blood sample. Participants were classified into three groups according to imaging findings; (1) CT+, (2) MRI+ (CT-), (3) Controls (CT- MRI-). Plasma levels of circulating cytokines (IL-6, IL-10, TNFα), and vascular endothelial growth factor (VEGF) were measured using an ultra-sensitive immunoassay. Concentrations of inflammatory cytokines (IL-6, TNFα) and VEGF were elevated in CT+, as well as MRI+ groups ( < 0.001), compared to controls, even after controlling for age, sex and cardiovascular disease (CVD)-related risk factors; hypertension, and hyperlipidemia. Post-concussive symptoms were associated with imaging groupings, but not inflammatory cytokines in this cohort. Levels of VEGF, IL-6, and TNFα differentiated patients with CT+ findings from controls, with the combined biomarker model (VEGF, IL-6, TNFα, and IL-10) showing good discriminatory power (AUC 0.92, 95% CI 0.87-0.97). IL-6 was a fair predictor of MRI+ findings compared to controls (AUC 0.70, 95% CI 0.60-0.78). Finally, the combined biomarker model discriminated patients with MRI+ from CT+ with an AUC of 0.71 (95% CI 0.62-0.80). When combined, IL-6, TNFα, and VEGF may provide a promising biomarker cytokine panel to differentiate mTBI patients with CT+ imaging vs. controls. Singularly, IL-6 was a fair discriminator between each of the imaging groups. Future research directions may help elucidate mechanisms related to injury severity and potentially, recovery following an mTBI.
血液中促炎细胞因子水平升高与急性中度至重度创伤性脑损伤(TBI)相关,但在急性轻度(m)TBI患者队列中了解较少。本研究探讨了血液中的细胞因子能否区分有无神经影像学表现(CT和MRI)的mTBI患者。在由格拉斯哥昏迷量表(GCS)评分13至15确定为mTBI后的24小时内,250名参与者接受了计算机断层扫描(CT)和磁共振成像(MRI)扫描,并提供了血样。参与者根据影像学表现分为三组:(1)CT阳性组,(2)MRI阳性组(CT阴性),(3)对照组(CT阴性且MRI阴性)。使用超灵敏免疫测定法测量循环细胞因子(IL-6、IL-10、TNFα)和血管内皮生长因子(VEGF)的血浆水平。与对照组相比,即使在控制了年龄、性别和心血管疾病(CVD)相关危险因素(高血压和高脂血症)后,CT阳性组以及MRI阳性组中炎症细胞因子(IL-6、TNFα)和VEGF的浓度仍升高(P<0.001)。在该队列中,脑震荡后症状与影像学分组有关,但与炎症细胞因子无关。VEGF、IL-6和TNFα的水平可区分CT阳性组患者与对照组,联合生物标志物模型(VEGF、IL-6、TNFα和IL-10)显示出良好的鉴别能力(曲线下面积[AUC]为0.92,95%置信区间[CI]为0.87-0.97)。与对照组相比,IL-6是MRI阳性表现的一个中等预测指标(AUC为0.70,95%CI为0.60-0.78)。最后,联合生物标志物模型区分MRI阳性组和CT阳性组患者的AUC为0.71(95%CI为0.62-0.80)。IL-6、TNFα和VEGF联合使用时,可能为区分有CT阳性影像学表现的mTBI患者与对照组提供一个有前景的生物标志物细胞因子组合。单独来看,IL-6在各影像学组之间是一个中等鉴别指标。未来的研究方向可能有助于阐明与损伤严重程度相关的机制,以及潜在的mTBI后的恢复机制。