Tan Haoyuan, Wang Jiamian, Li Fengshi, Peng Yidong, Lan Jin, Zhang Yuanda, Zhao Dongxu, Bao Yinghui
Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Neurologic Surgery Department, Huashan Hospital, Fudan University, Shanghai 200437, China.
Diagnostics (Basel). 2024 Jun 13;14(12):1245. doi: 10.3390/diagnostics14121245.
Traumatic brain injury (TBI) is a severe neurological condition characterized by inflammation in the central nervous system. SERPINA3 has garnered attention as a potential biomarker for assessing this inflammation. Our study aimed to explore the predictive value of postoperative serum SERPINA3 levels in identifying the risk of cerebral edema and its prognostic implications in TBI. This study is a prospective observational study, including 37 patients with TBI who finally met our criteria. The Glasgow Outcome Scale (GOS), Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), and Early Rehabilitation Barthel Index (ERBI) scores at six months after trauma were defined as the main study endpoint. We further calculated the ventricle-to-intracranial-volume ratio (VBR) at 6 months from CT scans. The study included patients with Glasgow Coma Scale (GCS) scores ranging from 3 to 8, who were subsequently categorized into two groups: the critical TBI group (GCS 3-5 points) and the severe TBI group (GCS 6-8 points). Within the critical TBI group, SERPINA3 levels were notably lower. However, among patients with elevated SERPINA3 levels, both the peak intracranial pressure (ICP) and average mannitol consumption were significantly reduced compared with those of patients with lower SERPINA3 levels. In terms of the 6-month outcomes measured via the GOS, LCF, DRS, and ERBI, lower levels of SERPINA3 were indicative of poorer prognosis. Furthermore, we found a negative correlation between serum SERPINA3 levels and the VBR. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) demonstrated the predictive performance of SERPINA3. In conclusion, incorporating the novel biomarker SERPINA3 alongside traditional assessment tools offers neurosurgeons an effective and easily accessible means, which is readily accessible early on, to predict the risk of intracranial pressure elevation and long-term prognosis in TBI patients.
创伤性脑损伤（TBI）是一种严重的神经系统疾病，其特征是中枢神经系统炎症。丝氨酸蛋白酶抑制剂A3（SERPINA3）作为评估这种炎症的潜在生物标志物已受到关注。我们的研究旨在探讨术后血清SERPINA3水平在识别创伤性脑损伤患者脑水肿风险及其预后意义方面的预测价值。本研究是一项前瞻性观察性研究，纳入了37例最终符合我们标准的创伤性脑损伤患者。创伤后6个月的格拉斯哥预后量表（GOS）、认知功能水平（LCF）、残疾评定量表（DRS）和早期康复Barthel指数（ERBI）评分被定义为主要研究终点。我们还根据CT扫描计算了6个月时的脑室与颅内体积比（VBR）。该研究纳入了格拉斯哥昏迷量表（GCS）评分为3至8分的患者，随后将其分为两组：重度创伤性脑损伤组（GCS 3 - 5分）和中度创伤性脑损伤组（GCS 6 - 8分）。在重度创伤性脑损伤组中，SERPINA3水平显著较低。然而，在SERPINA3水平升高的患者中，与SERPINA3水平较低的患者相比，峰值颅内压（ICP）和甘露醇平均消耗量均显著降低。就通过GOS、LCF、DRS和ERBI测量的6个月结局而言，较低的SERPINA3水平表明预后较差。此外，我们发现血清SERPINA3水平与VBR之间存在负相关。受试者工作特征（ROC）曲线和决策曲线分析（DCA）证明了SERPINA3的预测性能。总之，将新型生物标志物SERPINA3与传统评估工具相结合，为神经外科医生提供了一种有效且易于获取的方法，能够在早期就轻松预测创伤性脑损伤患者颅内压升高的风险和长期预后。
