中度创伤性颅脑损伤患者血清胶质纤维酸性蛋白和Tau蛋白水平变化及其与继发性认知障碍的关系

Changes of serum glial fibrillary acid protein and Tau protein levels in patients with moderate traumatic brain injury and their relationship with cognitive impairment

目的探讨中度创伤性颅脑损伤(TBI)患者血清胶质纤维酸性蛋白(GFAP)及Tau蛋白水平变化,分析其对继发性认知障碍的评估价值。方法选择2019年6月至2020年6月新乡医学院第一附属医院收治的87例中度TBI患者为观察组,另选择同期于新乡医学院第一附属医院体检健康者20例为对照组。观察组患者给予颅脑损伤常规药物保守治疗,于颅脑损伤后1个月根据蒙特利尔认知评估量表(MoCA)评分将患者分为TBI继发轻度认知障碍(MCI)组和TBI无MCI组。观察组TBI患者于颅脑损伤后1个月(T_(1))、2个月(T_(2))、3个月(T_(3))和对照组受试者体验时采集外周静脉血,应用酶联免疫吸附法测定受试者血清GFAP和Tau蛋白水平,比较2组患者血清GFAP和Tau蛋白水平,分析血清GFAP和Tau蛋白水平与TBI患者认知障碍的相关性。结果观察组患者T_(2)、T_(3)时血清GFAP和Tau蛋白水平显著高于T_(1)时,T_(3)时血清GFAP和Tau蛋白水平显著低于T_(2)时(P<0.05)。观察组患者T_(1)、T_(2)、T_(3)时血清GFAP和Tau蛋白水平显著高于对照组(P<0.05)。TBI继发MCI组和TBI无MCI组患者T_(2)、T_(3)时血清GFAP和Tau蛋白水平显著高于T_(1)时,T_(3)时血清GFAP和Tau蛋白水平显著低于T_(2)时(P<0.05);T_(1)、T_(2)、T_(3)时,TBI继发MCI组患者血清GFAP和Tau蛋白水平显著高于TBI无MCI组(P<0.05)。TBI继发MCI患者血清GFAP和Tau蛋白水平与MoCA评分呈负相关(r=-0.875、-0.852,P<0.001)。结论TBI患者血清GFAP和Tau蛋白水平明显升高,其与继发认知障碍有一定相关性,可作为TBI早期诊断和继发认知障碍判断的生物学指标。

Objective To investigate the changes of serum glial fibrillary acidic protein(GFAP)and Tau protein levels in patients with moderate traumatic brain injury(TBI),and analyze their value in evaluating the cognitive impairment.Methods A total of 87 patients with moderate TBI admitted to the First Affiliated Hospital of Xinxiang Medical University from June 2019 to June 2020 were selected as the observation group,and 20 healthy subjects who underwent physical examination in the First Affiliated Hospital of Xinxiang Medical University at the same time were selected as the control group.The patients in the observation group were treated with conventional drugs for craniocerebral injury.One month after craniocerebral injury,the patients were divided into TBI combined with mild cognitive impairment(MCI)group and TBI without MCI group accroding to Montreal Cognitive Assessment Scale(MoCA)score.Peripheral venous blood of the subjects in the control group during physical examination and patients with TBI in the observation group at 1 month(T_(1)),2 months(T_(2))and 3 months(T_(3))after craniocerebral injury were collected.The levels of serum GFAP and Tau protein were measured by enzyme-linked immunosorbent assay.The level of serum GFAP and Tau protein levels of the subjects between the two groups were compared,and the correlation between GFAP,Tau protein levels and cognitive impairment of TBI patients was analyzed.Results The levels of serum GFAP and Tau protein at T_(2)and T_(3)were significantly higher than those at T_(1)in the observation group,and the levels of serum GFAP and Tau protein at T_(3)were significantly lower than those at T_(2)(P<0.05).The levels of serum GFAP and Tau protein of patients in the observation group at T_(1),T_(2)and T_(3)were significantly higher than those in the control group(P<0.05).The levels of serum GFAP and Tau protein of patients at T_(2)and T_(3)were significantly higher than those at T_(1)in the TBI combined with MCI group and TBI without MCI group,and the levels of serum GFAP and Tau protein at T_(3)were significantly lower than those at T_(2)(P<0.05);at T_(1),T_(2),T_(3),the levels of serum GFAP and Tau protein of patients in the TBI combined with MCI group were significantly higher than those in the TBI without MCI group(P<0.05).The level of serum GFAP and Tau protein were negatively correlated with MOCA score in patients with TBI combined with MCI(r=-0.875,-0.852;P<0.001).Conclusion The levels of serum GFAP and Tau protein in patients with TBI increased significantly,and they have a certain correlation with secondary cognitive impairment,and they can be used as biological indexes for the early diagnosis of TBI and the judgment of secondary cognitive impairment.