Chen Weiliang, Wang Guanjun, Yao Chunyu, Zhu Zujian, Chen Rui, Su Wen, Jiang Rongcai
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in the Central Nervous System, Tianjin Key Laboratory of Injury and Regenerative Medicine of Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin Medical University, Tianjin, China.
Front Neurol. 2022 Sep 1;13:887818. doi: 10.3389/fneur.2022.887818. eCollection 2022.
Moderate to severe traumatic brain injury (TBI) is frequently accompanied by diffuse axonal injury (DAI). Considering the low sensitivity of computed tomography (CT) examination for microbleeds and axonal damage, identification of DAI is difficult using conventional diagnostic methods in the acute phase. Neuron-specific enolase (NSE) has been demonstrated to be increased in serum following various types of TBI and is already clinically/commercially available. We conjecture that serum NSE level to admission GCS score ratio (NGR) may be a useful indicator for the early diagnosis of DAI.
This study included 115 patients with moderate-to-severe TBI who underwent NSE measurements within 6 h after injury and brain magnetic resonance imaging (MRI) within 30 days. The positive and negative DAI groups were divided according to MRI findings.
Among the 115 patients, 49 (42.6%) were classified into the DAI group and 66 (57.4%) patients into the non-DAI group by clinical MRI. The NGR of patients without DAI was found to be significantly lower than those of patients with DAI ( < 0.0001). NGR presented the largest Pearson value ( = 0.755, 95% CI 0.664-0.824, < 0.0001) and high diagnostic accuracy for DAI [area under the curve (AUC) = 0.9493; sensitivity, 90.91%; and specificity, 85.71%]. Patients with TBI presenting with higher NGR were more likely to suffer an unfavorable neurological outcome [6-month extended Glasgow Outcome Scale (GOSE) 1-4].
The NGR on admission could serve as an independent predictor of DAI with moderate-to-severe TBI.
中重度创伤性脑损伤（TBI）常伴有弥漫性轴索损伤（DAI）。鉴于计算机断层扫描（CT）检查对微出血和轴索损伤的敏感性较低，在急性期使用传统诊断方法难以识别DAI。神经元特异性烯醇化酶（NSE）已被证明在各类TBI后血清中会升高，且已在临床/商业上可用。我们推测血清NSE水平与入院时格拉斯哥昏迷量表（GCS）评分的比值（NGR）可能是DAI早期诊断的有用指标。
本研究纳入了115例中重度TBI患者，这些患者在受伤后6小时内进行了NSE测量，并在30天内进行了脑磁共振成像（MRI）检查。根据MRI结果将DAI阳性和阴性组进行划分。
在115例患者中，通过临床MRI，49例（42.6%）被归类为DAI组，66例（57.4%）患者被归类为非DAI组。发现无DAI患者的NGR显著低于有DAI患者（<0.0001）。NGR呈现出最大的Pearson值（=0.755，95%CI 0.664 - 0.824，<0.0001），对DAI具有较高的诊断准确性[曲线下面积（AUC）=0.9493；敏感性，90.91%；特异性，85.71%]。NGR较高的TBI患者更有可能出现不良神经学结局[6个月扩展格拉斯哥预后量表（GOSE）1 - 4级]。
入院时的NGR可作为中重度TBI患者DAI的独立预测指标。
