Turchan Agus, Fahmi Achmad, Kurniawan Achmad, Bajamal Abdul Hafid, Fauzi Asra, Apriawan Tedy
Department of Neurosurgery, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
Surg Neurol Int. 2022 Jun 17;13:250. doi: 10.25259/SNI_1245_2021. eCollection 2022.
Mortality predictions following traumatic brain injury (TBI) may be improved by including genetic risk in addition to traditional prognostic variables. One promising target is the gene coding for brain-derived neurotrophic factor (BDNF), a ubiquitous neurotrophin important for neuronal survival and neurogenesis.
A total of seven publications pertaining to BDNF in the study of traumatic head injury were included and reviewed. The majority of patients were male, that is, 483 (83.85%) patients, compared to 93 (16.15%) female patients. The median length of follow-up was 6 months (3 days-12 months). Measurement of the patient's initial condition was carried out by measuring the initial GCS of the patient at the time of admission across the five studies being 6.5. The median CSF BDNF levels in the unfavorable group being 0.2365 (0.19-0.3119) ng/ml, from favorable group which was 0.20585 (0.17-0.5526) ng/ml. The median serum BDNF level in the unfavorable group being 3.9058 (0.6142-13.0) ng/ml, from favorable group which was 4.3 (0.6174-23.3) ng/ml.
Six studies reported on the sex distribution of patients, the majority of patients were male, that is, 483 (83.85%) patients, compared to 93 (16.15%) female patients. Six studies reported the number of patients per outcome group. The comparison of the number of patients in the two groups was quite balanced with the number of patients in the good group as many as 269 patients (55.5%) and the number of patients in the unfavorable group as many as 216 patients (44.5%). Measurement of the patient's initial condition was carried out by measuring the patient's initial GCS at the time of admission. It was reported in five studies, with the overall mean baseline GCS across five studies being 6.5 (3.2-8.8). Measurement of patient outcome was carried out by several methods, two studies used Glasgow Outcome Scale, Glasgow Outcome Scale Extended was used in two studies, and five studies used survival as a patient outcome measure. The patient's BDNF level was measured in CSF and/or serum. A total of four studies measuring BDNF CSF levels and serum BDNF levels. Measurement of BDNF levels in TBI patients conducted on patients in seven literatures showed that there were differences in the trend of BDNF levels from CSF sources and serum sources. Measurement of CSF BDNF levels CSF BDNF levels was reported in two of the seven literatures, with the median CSF BDNF level in the unfavorable group being 0.2365 (0.19-0.3119) ng/ml. CSF BDNF levels were higher than the median in the preferred group, which was 0.20585 (0.17-0.5526) ng/ml. The results of the analysis from three other literatures stated that there was a tendency for lower CSF BDNF levels in the preferred group. Serum BDNF levels were reported in two of the seven literatures, with the median serum BDNF level in the unfavorable group being 3.9058 (0.6142-13.0) ng/ml. This serum BDNF level was lower than the median in the preferred group, which was 4.3 (0.6174-23.3) ng/ml. The results of the analysis of four literatures reporting serum BDNF stated that there was a tendency for lower serum BDNF levels in the poor group. A risk assessment of bias for each study was performed using ROBINS-I because all included studies were non-RCT studies. Overall the results of the risk of bias analysis were good, with the greatest risk of confounding bias and outcome bias.
Serum BDNF levels were found to be lower in the unfavorable group than in the favorable group. This is associated with an increase in autonomic function as well as a breakdown of the blood-brain barrier which causes a decrease in serum BDNF levels. Conversely, CSF BDNF levels were found to be higher in the unfavorable group than in the favorable group. This is associated with an increase in the breakdown of the blood-brain barrier which facilitates the transfer of serum BDNF to the brain, leading to an increase in CSF BDNF levels.
除了传统的预后变量外，纳入遗传风险因素可能会改善创伤性脑损伤（TBI）后的死亡率预测。一个有前景的靶点是编码脑源性神经营养因子（BDNF）的基因，BDNF是一种普遍存在的神经营养因子，对神经元存活和神经发生很重要。
共纳入并综述了七篇关于BDNF在创伤性颅脑损伤研究中的文献。大多数患者为男性，即483例（83.85%），女性患者93例（16.15%）。随访时间中位数为6个月（3天至12个月）。在五项研究中，通过测量患者入院时的初始格拉斯哥昏迷量表（GCS）来评估患者的初始状况，其值为6.5。不良组脑脊液BDNF水平中位数为0.2365（0.19 - 0.3119）ng/ml，良好组为0.20585（0.17 - 0.5526）ng/ml。不良组血清BDNF水平中位数为3.9058（0.6142 - 13.0）ng/ml，良好组为4.3（0.6174 - 23.3）ng/ml。
六项研究报告了患者的性别分布，大多数患者为男性，即483例（83.85%），女性患者93例（16.15%）。六项研究报告了每个结局组的患者数量。两组患者数量比较相当均衡，良好组患者269例（55.5%），不良组患者216例（44.5%）。通过测量患者入院时的初始GCS来评估患者的初始状况。五项研究中有报告，五项研究的总体平均基线GCS为6.5（3.2 - 8.8）。通过多种方法评估患者结局，两项研究使用格拉斯哥结局量表，两项研究使用扩展格拉斯哥结局量表，五项研究将生存作为患者结局指标。在脑脊液和/或血清中测量患者的BDNF水平。共有四项研究测量了脑脊液BDNF水平和血清BDNF水平。对七篇文献中TBI患者BDNF水平的测量表明，脑脊液来源和血清来源的BDNF水平趋势存在差异。七篇文献中有两篇报告了脑脊液BDNF水平，不良组脑脊液BDNF水平中位数为0.2365（0.19 - 0.3119）ng/ml。脑脊液BDNF水平高于良好组中位数，良好组为0.20585（0.17 - 0.5526）ng/ml。其他三篇文献的分析结果表明，良好组脑脊液BDNF水平有降低趋势。七篇文献中有两篇报告了血清BDNF水平，不良组血清BDNF水平中位数为3.
