Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland.
Neurosurg Rev. 2022 Apr;45(2):1171-1193. doi: 10.1007/s10143-021-01678-z. Epub 2021 Oct 28.
Biomarkers such as calcium channel binding protein S100 subunit beta (S100B), glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1) and neuron-specific enolase (NSE) have been proposed to aid in screening patients presenting with mild traumatic brain injury (mTBI). As such, we aimed to characterise their accuracy at various thresholds. MEDLINE, SCOPUS and EMBASE were searched, and articles reporting the diagnostic performance of included biomarkers were eligible for inclusion. Risk of bias was assessed using the QUADAS-II criteria. A meta-analysis was performed to assess the predictive value of biomarkers for imaging abnormalities on CT. A total of 2939 citations were identified, and 38 studies were included. Thirty-two studies reported data for S100B. At its conventional threshold of 0.1 μg/L, S100B had a pooled sensitivity of 91% (95%CI 87-94) and a specificity of 30% (95%CI 26-34). The optimal threshold for S100B was 0.72 μg/L, with a sensitivity of 61% (95% CI 50-72) and a specificity of 69% (95% CI 64-74). Nine studies reported data for GFAP. The optimal threshold for GFAP was 626 pg/mL, at which the sensitivity was 71% (95%CI 41-91) and specificity was 71% (95%CI 43-90). Sensitivity of GFAP was maximised at a threshold of 22 pg/mL, which had a sensitivity of 93% (95%CI 73-99) and a specificity of 36% (95%CI 12-68%). Three studies reported data for NSE and two studies for UCH-L1, which precluded meta-analysis. There is evidence to support the use of S100B as a screening tool in mild TBI, and potential advantages to the use of GFAP, which requires further investigation.
生物标志物，如钙通道结合蛋白 S100 亚基β（S100B）、神经胶质纤维酸性蛋白（GFAP）、泛素 C 端水解酶 L1（UCH-L1）和神经元特异性烯醇化酶（NSE），已被提议用于辅助筛选出现轻度创伤性脑损伤（mTBI）的患者。因此，我们旨在确定这些标志物在不同阈值下的准确性。我们检索了 MEDLINE、SCOPUS 和 EMBASE，并纳入了报告包括标志物在内的诊断性能的文章。使用 QUADAS-II 标准评估偏倚风险。进行了荟萃分析以评估生物标志物对 CT 成像异常的预测价值。共识别出 2939 条引文，纳入了 38 项研究。32 项研究报告了 S100B 的数据。在其传统的 0.1μg/L 阈值下，S100B 的合并敏感性为 91%（95%CI 87-94），特异性为 30%（95%CI 26-34）。S100B 的最佳阈值为 0.72μg/L，其敏感性为 61%（95%CI 50-72），特异性为 69%（95%CI 64-74）。9 项研究报告了 GFAP 的数据。GFAP 的最佳阈值为 626pg/mL，此时敏感性为 71%（95%CI 41-91），特异性为 71%（95%CI 43-90）。在阈值为 22pg/mL 时，GFAP 的敏感性最高，为 93%（95%CI 73-99），特异性为 36%（95%CI 12-68%）。有 3 项研究报告了 NSE 的数据，有 2 项研究报告了 UCH-L1 的数据，因此无法进行荟萃分析。有证据支持 S100B 作为轻度 TBI 的筛查工具，而 GFAP 也有潜在的优势，需要进一步研究。
