脊髓损伤中脑脊液和血清神经丝光和胶质纤维酸性蛋白与损伤严重程度和预后的关系[j] - Neurology . JO - Neurology . SP - e1221 LP - e1233 DO . 10.1212/WNL.0000000000206744首页六世- 100 - 12盟——苏菲架斯图卡俯冲轰炸机盟——詹妮弗·库珀AU -茉莉花吉尔AU -纳德Fallah AU - Michael a . Skinnider AU -丽丝Belanger盟李安娜里奇AU -安吉拉曾AU -凯文盾盟Femke Streijger AU -约翰街盟-斯科特Paquette AU -塔米尔Ailon AU -尼古拉斯Dea非盟Raphaele Charest-Morin盟——查尔斯·g·费舍尔AU -克里斯托弗·s·贝利盟桑杰迪豪AU - jean - marc Mac-Thiong AU -杰弗逊·r·威尔逊盟-肖恩·克里斯蒂AU -马塞尔·f·德沃夏克盟Cheryl l .惠灵顿盟- Brian K. Kwon Y1 - 2023/03/21 UR - //www.ez-admanager.com/content/100/12/e1221.abstract N2 - Background and Objectives Traumatic spinal cord injury (SCI) is highly heterogeneous, and tools to better delineate pathophysiology and recovery are needed. Our objective was to profile the response of 2 biomarkers, neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP), in the serum and CSF of patients with acute SCI to evaluate their ability to objectively characterize injury severity and predict neurologic recovery.Methods Blood and CSF samples were obtained from prospectively enrolled patients with acute SCI through days 1–4 postinjury, and the concentration of NF-L and GFAP was quantified using Simoa technology. Neurologic assessments defined the ASIA Impairment Scale (AIS) grade and motor score (MS) at presentation and 6 months postinjury.Results One hundred eighteen patients with acute SCI (78 AIS A, 20 AIS B, and 20 AIS C) were enrolled, with 113 (96%) completing 6-month follow-up. NF-L and GFAP levels were strongly associated between paired serum and CSF specimens, were both increased with injury severity, and distinguished among baseline AIS grades. Serum NF-L and GFAP were significantly (p = 0.02 to <0.0001) higher in AIS A patients who did not improve at 6 months, predicting AIS grade conversion with a sensitivity and specificity (95% CI) of 76% (61, 87) and 77% (55, 92) using NF-L and 72% (57, 84) and 77% (55, 92) using GFAP at 72 hours, respectively. Independent of clinical baseline assessment, a serum NF-L threshold of 170 pg/mL at 72 hours predicted those patients who would be classified as motor complete (AIS A/B) compared with motor incomplete (AIS C/D) at 6 months with a sensitivity of 87% (76, 94) and specificity of 84% (69, 94); a serum GFAP threshold of 13,180 pg/mL at 72 hours yielded a sensitivity of 90% (80, 96) and specificity of 84% (69, 94).Discussion The potential for NF-L and GFAP to classify injury severity and predict outcome after acute SCI will be useful for patient stratification and prognostication in clinical trials and inform communication of prognosis.Classification of Evidence This study provides Class I evidence that higher serum NF-L and GFAP are associated with worse neurological outcome after acute SCI.Trial Registration Information Registered on ClinicalTrials.gov: NCT00135278 (March 2006) and NCT01279811 (January 2012).AIS=ASIA Impairment Scale; ASIA=American Spinal Injury Association; AUROC=area under the ROC; BTI=brain trauma indicator; GFAP=glial fibrillary acidic protein; ISNCSCI=International Standards for Neurological Classification of Spinal Cord Injury; IQR=interquartile range; LDA=linear discriminant analysis; LEMS=lower extremity MS; MS=motor score; NF-L=neurofilament light; OR=odds ratio; ROC=receiver operating characteristic; SCI=spinal cord injury; TBI=traumatic brain injury; UEMS=upper extremity MS; ULOD=upper limit of detection; ULOQ=upper limit of quantification; ZPP=zone of partial preservation ER -