老年颅脑损伤者术后血清和脑脊液NFL、GFAP对继发交通性脑积水的预测价值

Predictive value of postoperative serum and cerebrospinal fluid NFL and GFAP in elderly patients with traumatic brain injury on secondary communicating hydrocephalus

目的研究老年颅脑损伤患者术后血清和脑脊液(CSF)神经丝蛋白轻链(NFL)、胶质纤维酸性蛋白(GFAP)对继发交通性脑积水的预测价值。方法回顾性分析2018年6月-2022年2月对我院神经外科收治的116例老年颅脑损伤患者,根据患者进行去骨瓣减压术和侧脑室外引流出院后至少随访6个月的临床诊断结果,将患者分为继发交通性脑积水组30例和非脑积水组86例。采集术后即刻、术后24h和48h引流的CSF,同时采集血清,采用酶联免疫分析法检测NFL、GFAP水平。结果CSF NFL、GFAP水平存在时间、组别以及时间和组别交互作用(P<0.05)。在术后即刻、术后24 h、48 h时,继发脑积水组CSF NFL、GFAP水平均高于非脑积水组(均P<0.05);而且与术后即刻相比,随着EVD引流时间的延长,CSF NFL、GFAP水平逐渐降低(均P<0.05)。经多因素Logistic回归分析,术后即刻CSF NFL、GFAP是影响老年颅脑损伤患者术后继发交通性脑积水的独立危险因素(P<0.05)。此外,术后即刻血清和CSF中NFL、GFAP水平均呈正相关性(r=0.669,0.797,P<0.001)。以非脑积水组作为对照,经受试者工作特征曲线分析,术后血清NFL+GFAP或CSF NFL+GFAP预测老年颅脑损伤者术后继发交通性脑积水的AUC分别为0.910(95%CI:0.856~0.964)、0.966(95%CI:0.937~0.994)。结论检测术后即刻血清和CSF中NFL、GFAP水平可以有效地预测老年颅脑损伤者去骨瓣减压术后继发交通性脑积水的发生风险。

Objective To study the predictive value of serum and cerebrospinal fluid(CSF)neurofilament light chain(NFL)and glial fibrillary acidic protein(GFAP)in elderly patients with traumatic brain injury(TBI)after surgery.Methods A retrospective analysis of 116 cases of craniocerebral injury elderly patients admitted to our hospital from April 2018 to February 2020.According to the clinical diagnosis results of at least 6 months of follow-up after decompressive craniectomy and external ventricular drainage(EVD),the patients were divided into 30 cases of secondary communicating hydrocephalus group and 86 cases of non-hydrocephalus group.CSF drained immediately,24h and 48h after operation were collected,and serum at the same time were also collected.NFL and GFAP levels were analyzed by enzyme-linked immunoassay.Results CSF NFL and GFAP levels existed for time,group and interaction between time and group(P<0.05).The levels of CSF NFL and GFAP in the secondary hydrocephalus group were higher than those in the non hydrocephalus group immediately,24h and 48h after operation(all P<0.05);compared with immediately after operation,with the prolongation of EVD drainage time,the levels of CSF NFL and GFAP decreased gradually(all P<0.05).Multiple Logistic regression analysis showed CSF NFL and GFAP immediately after surgery were the independent risk factors for the development of communicating hydrocephalus in elderly patients with traumatic brain injury(P<0.05).Besides,there was a positive correlation between serum and CSF NFL and GFAP levels immediately after surgery(r=0.669,0.797,P<0.001).With the non-hydrocephalus group as a control,after ROC curve analysis,the area of the receiver operating characteristic curve for the serum NFL+GFAP or CSF NFL+GFAP immediately after surgery predicted postoperative hydrocephalus were 0.910(95%CI:0.856~0.964)and 0.966(95%CI:0.937~0.994).Conclusion Detection of NFL and GFAP levels in serum and CSF immediately after operation can effectively predict the risk of secondary communicating hydrocephalus in elderly patients with craniocerebral injury after decompressive craniectomy.