预测 GFAP 和 UCH-L1 生物标志物在自发性蛛网膜下腔出血中的作用：一项初步研究，评估其在短期内与出血严重程度和预后的相关性。

Predicting Role of GFAP and UCH-L1 biomarkers in Spontaneous Subarachnoid Hemorrhage: a preliminary study to evaluate in the short-term their correlation with severity of bleeding and prognosis.

机构信息

Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Corelab, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy.

出版信息

J Clin Neurosci. 2024 Aug;126:119-127. doi: 10.1016/j.jocn.2024.06.003. Epub 2024 Jun 12.

DOI:10.1016/j.jocn.2024.06.003

PMID:38870641

Abstract

BACKGROUND

Spontaneous non-traumatic subarachnoid hemorrhage (sSAH) is a severe brain vascular accident. Glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) can be theoretically assayed to predict a patient's progression, picturing different aspects of clinical failure after sSAH. The study aims to: a) explore the correlation between sSAH blood volume and biomarkers variation; b) evaluate if these can be predictive of the neurogenic response after sSAH and be prognostic of patient outcome; c) establish eventual threshold levels of biomarkers to define patients' clinical outcome.

METHODS

Blood volumetry at CT scan upon admission, GFAP and UCH-L1 were collected at 24 h, at 72 h, and after 7 days from hemorrhage. Trends and cut-off serum sampling were determined. Clinical outcome was assessed with mRS scale at 14 days.

RESULTS

A strong correlation between GFAP and UCH-L1 and blood diffusion volume in all explored serum intervals related to unfavorable outcome. GFAP and UCH-L1 were very early predictors of unfavorable outcomes at 24 h from sSAH (p = 0.002 and 0.011 respectively). Threshold levels of UCH-L1 apparently revealed a very early, early and late predictor of unfavorable outcomes.

CONCLUSION

GFAP and UCH-L1 represent a potential tool for prompt monitoring and customization of therapies in neurosurgical patients.

摘要

背景

自发性非外伤性蛛网膜下腔出血（sSAH）是一种严重的脑血管意外。胶质纤维酸性蛋白（GFAP）和泛素羧基末端水解酶 L1（UCH-L1）可用于理论上预测患者的进展情况，描绘 sSAH 后不同临床失败的方面。本研究旨在：a）探讨 sSAH 血量与生物标志物变化之间的相关性；b）评估它们是否可以预测 sSAH 后的神经源性反应，并对患者预后进行预测；c）确定生物标志物的最终阈值水平，以定义患者的临床结局。

方法

入院时行 CT 扫描测量出血量，在出血后 24 小时、72 小时和 7 天采集 GFAP 和 UCH-L1。确定趋势和最佳血清采样时间。采用 mRS 量表在 14 天评估临床结局。

结果

在所有探索的与不良结局相关的血清间隔中，GFAP 和 UCH-L1 与血液扩散量之间存在很强的相关性。GFAP 和 UCH-L1 是 sSAH 后 24 小时不良结局的非常早期预测指标（p 值分别为 0.002 和 0.011）。UCH-L1 的阈值水平明显显示了不良结局的非常早期、早期和晚期预测指标。