Glymphatic Function as a Prognostic Biomarker in Prolonged Disorders of Consciousness

IF 5 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-07-23 DOI:10.1111/cns.70526

Dian-Wei Wu, Chang-Geng Song, Rong Chen, Jing-Jing Zhao, Ying-Chi Zhang, Xuan Wang, Zhong-Qing Sun, Xiao-Gang Kang, Qiong Gao, Wen Jiang

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Abstract

Objective

The glymphatic system is a major waste clearance system in the central nervous system. We aim to investigate the glymphatic function and its prognostic values in patients with prolonged disorders of consciousness (pDoC).

Methods

We conducted a prospective and explorative cohort study including 40 patients with pDoC and 20 healthy controls. Glymphatic function was measured with the global and regional blood-oxygen-level-dependent and cerebrospinal fluid (BOLD-CSF) couplings, characterized by time-lags and strengths of the couplings. The clinical outcome was defined as improvement and no improvement in consciousness 6 months after enrollment, determined via a structured telephone follow-up based on the Coma Recovery Scale-Revised (CRS-R) score.

Results

Patients with pDoC exhibited significantly delayed time-lags in BOLD-CSF coupling (p < 0.05) and significantly reduced coupling strengths (p < 0.05) when compared to healthy controls. Follow-up studies indicated that shorter global BOLD-CSF coupling time-lags can predict an improved consciousness 6 months after enrollment, with an area under the receiver operating characteristic curve of 0.837, a sensitivity of 82.4%, and an accuracy of 85.7% using a cutoff point of 7.5.

Conclusion

The glymphatic system was impaired in patients with pDoC, and its function, measured by BOLD-CSF coupling, can serve as a novel prognostic biomarker.

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淋巴功能作为长期意识障碍的预后生物标志物

目的淋巴系统是中枢神经系统中主要的废物清除系统。我们旨在探讨延长性意识障碍（pDoC）患者的淋巴功能及其预后价值。方法采用前瞻性和探索性队列研究，包括40例pDoC患者和20例健康对照。Glymphatic功能是通过全球和区域血氧水平依赖性和脑脊液（BOLD-CSF）耦合来测量的，其特征是耦合的时间滞后和强度。临床结果定义为入组后6个月意识改善或无改善，通过基于昏迷恢复量表修订（CRS-R）评分的结构化电话随访确定。结果与健康对照相比，pDoC患者BOLD-CSF耦合时滞显著延迟（p < 0.05），耦合强度显著降低（p < 0.05）。随访研究表明，较短的整体BOLD-CSF耦合滞后可以预测入组后6个月的意识改善，受试者工作特征曲线下面积为0.837，灵敏度为82.4%，截断点为7.5，准确率为85.7%。结论pDoC患者淋巴系统功能受损，通过BOLD-CSF偶联检测其功能可作为一种新的预后生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.