急性创伤性脑损伤患者血清Tau蛋白动态变化及其与认知功能障碍的相关性研究

Dynamic changes of serum Tau proteins and their correlation with cognitive dysfunction in patients with acute traumatic brain injury

目的探讨急性创伤性脑损伤（TBI）患者血清Tau蛋白的动态变化及其与认知功能障碍的相关性。方法采用回顾性病例对照研究分析2014年10月-2016年6月收治的95例急性TBI患者（TBI组）的临床资料，其中男61例，女34例；年龄16～65岁[（40．7±13．6）岁]。格拉斯哥昏迷评分（GCS）3～8分9例，9～12分11例，13～15分75例。正常对照组为30例健康体检者。分别于TBI后1，3，5，7，14d检测患者血清Tau蛋白含量的动态变化。TBI后6个月采用蒙特利尔认知评估量表（MoCA）评估患者认知功能障碍，同时比较各时相点血清Tau蛋白含量与患者TBI后6个月MoCA评分的相关性。结果TBI组患者血清Tau蛋白含量在TBI后各时相点均显著高于对照组（P均〈0．05）。TBI组患者伤后6个月发生认知功能障碍39例（41％），主要表现为视空间与执行功能、延迟记忆、语言能力、抽象能力、注意力和计算力障碍，与无认知功能障碍患者差异有统计学意义（P均〈0．05）。认知功能障碍患者的血清Tau蛋白含量在TBI后各时相点均显著高于无认知功能障碍患者（P均〈0．05）。TBI后1，3，5d血清Tau蛋白含量与TBI后6个月认知功能障碍呈正相关（P〈0．05）。结论TBI后患者血清Tau蛋白含量显著升高，且其早期变化与认知功能障碍密切相关。TBI后早期血清Tau蛋白变化对患者认知功能障碍预后具有预测价值。

Objective To investigate dynamic changes of serum Tau proteins and their correlation with cognitive dysfunction in patients with acute traumatic brain injury （TBI）. Methods A total of 95 patients with acute TBI were retrospectively studied by case-control study. There were 61 males and 34 females, with age of 16-65 years [ （40.7 ± 13.6）years]. The Glasgow coma scale （GCS） was 3-8 points in 9 patients, 9-12 points in 11, and 13-15 points in 75. A total of 30 healthy physical examinees were recruited as control group. The levels of Tau proteins were measured at days 1, 3, 5, 7 and 14 after TBI. The cognitive dysfunction was evaluated by the Montreal Cognitive Assessment （MoCA） score at 6 months after injury. The correlation between Tau protein levels at different time points and MoCA was determined. Results The serum Tau proteins of TBI group was significantly higher than that of control group at all time points （P 〈 0.05）. In TBI group, 39 （41%） out of 95 patients developed cognitive dysfunction assessed by MoCA scale. The main manifestations of cognitive dysfunction were the defects in visual spatial and acting function, delayed memory, language, abstract, attention and calculation, with statistical significance compared with control group （ allP 〈 0.05 ）. The serum Tau proteins of patients with cognitive dysfunction were significantly higher than those without cognitive dysfunction at all time points after TBI （ P 〈 0.05 ）. Tau proteins at days 1, 3, 5 after TBI was significantly correlated with cognitive dysfunction at 6 months after TBI （ P 〈 0.05 ）. Conclusions The levels of serum Tau proteins show a significant increase after TBI, the early changes of which are statistically related to cognitive dysfunction. The early changes of serum Tau protein after TBI can be used as a reliable biomarker for early prediction of cognitive function prognosis.