Marijan Klarica, Department of Pharmacology and Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Šalata 2, 10000 Zagreb, Croatia,
Croat Med J. 2024 Aug 31;65(4):328-338. doi: 10.3325/cmj.2024.65.328.
To examine whether changes in biomarker concentrations in patients with idiopathic normal-pressure hydrocephalus (iNPH) during 72 h of external lumbar drainage (ELD) can differentiate between responders and non-responders.
Twenty patients with clinical and neuroradiological signs of iNPH underwent ELD over a period of 72 h. During this period, changes in cerebrospinal fluid (CSF) concentrations of biomarkers (amyloid-β, total and phosphorylated tau proteins) and intracranial pressure were monitored, and the volume of drained CSF was measured. Changes in the concentrations of selected biomarkers at three time points (0, 36, and 72 h) during ELD were tested for association with changes in clinical condition.
Ten patients showed significant clinical improvement after ELD, quantified as a difference of two or more points on the Mini-Mental State Examination and/or Japanese iNPH grading scale. The concentration of all tested biomarkers increased during the first 36 h. Respondents had higher Aβ 1-42 at all time points, with a significant difference seen after 72 h. They also had a significantly higher Aβ1-42/Aβ1-40 ratio at all time points.
A gradual increase in Aβ 1-42 concentration during three-day ELD represents a possible positive prognostic factor for the placement of permanent CSF drainage in patients with iNPH.
探讨特发性正常压力脑积水（iNPH）患者在 72 小时外腰椎引流（ELD）期间生物标志物浓度的变化是否可以区分反应者和非反应者。
20 例具有 iNPH 的临床和神经影像学征象的患者接受了为期 72 小时的 ELD。在此期间，监测脑脊液（CSF）中生物标志物（淀粉样蛋白-β、总tau 蛋白和磷酸化 tau 蛋白）浓度和颅内压的变化，并测量排出的 CSF 量。在 ELD 期间三个时间点（0、36 和 72 小时）的选定生物标志物浓度的变化与临床状况的变化进行了关联测试。
10 例患者在 ELD 后表现出明显的临床改善，表现为简易精神状态检查和/或日本 iNPH 分级量表上的差异为 2 分或更多。所有测试生物标志物的浓度在最初的 36 小时内增加。反应者在所有时间点的 Aβ 1-42 更高，72 小时后有显著差异。他们在所有时间点的 Aβ1-42/Aβ1-40 比值也明显更高。
在为期三天的 ELD 期间 Aβ 1-42 浓度的逐渐增加可能是 iNPH 患者永久性 CSF 引流的一个潜在的阳性预后因素。
