对评估神经胶质纤维酸性蛋白 (GFAP) 和泛素 C 端水解酶 L1 (UCHL1) 作为成年受试者轻度急性创伤性脑损伤 (mTBI) 或运动相关脑震荡 (SRC) 血液生物标记物的观察性研究进行系统回顾和荟萃分析。

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL
Diagnosis Pub Date : 2024-08-20 DOI:10.1515/dx-2024-0078
Paolo Mastandrea, Silvia Mengozzi, Sergio Bernardini
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引用次数: 0

摘要

导言:神经创伤是导致人类死亡的主要原因:由于不同研究之间存在高度异质性,我们对同一受试者的血液GFAP和UCHL1水平进行了评估。我们确定了 ROC 曲线下面积(AUC)、灵敏度、特异性和实验室值(以 ng/L 为单位)之间的生物标志物一致性,以避免出现虚假结果。最终的荟萃分析包括 8 项研究中的 1,880 名受试者。偏倚风险最高的项目如下:未预先指定截断点,未避免病例对照设计。GFAP的AUC大于UCHL1的AUC,GFAP的预测区间(PI)下限为50.1%,UCHL1的预测区间(PI)下限为37.3%,GFAP Sp的比例明显更高。GFAP和UCHL1的实验室结果的PI分别为0.517-7,518 ng/L(患病)、1.2-255 ng/L(未患病)和3-4,180 vs. 3.2-1,297 ng/L。摘要:只有GFAP阳性临界值(255 ng/L)似乎是可靠的。展望未来:展望:GFAP 需要更好的标准化。不过,磷酸-Tau 蛋白和磷酸-Tau/Tau 蛋白的 AUC 并未明显低于 GFAP 的 AUC,但这一结果还需进一步验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Systematic review and meta-analysis of observational studies evaluating glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCHL1) as blood biomarkers of mild acute traumatic brain injury (mTBI) or sport-related concussion (SRC) in adult subjects.

Introduction: Neurotrauma is the leading cause of death in individuals <45 years old. Many of the published articles on UCHL1 and GFAP lack rigorous methods and reporting.

Content: Due to the high heterogeneity between studies, we evaluated blood GFAP and UCHL1 levels in the same subjects. We determined the biomarker congruence among areas under the ROC curves (AUCs), sensitivities, specificities, and laboratory values in ng/L to avoid spurious results. The definitive meta-analysis included 1,880 subjects in eight studies. The items with the highest risk of bias were as follows: cut-off not prespecified and case-control design not avoided. The AUC of GFAP was greater than the AUC of UCHL1, with a lower prediction interval (PI) limit of 50.1 % for GFAP and 37.3 % for UCHL1, and a significantly greater percentage of GFAP Sp. The PI of laboratory results for GFAP and UCHL1 were 0.517-7,518 ng/L (diseased), 1.2-255 ng/L (nondiseased), and 3-4,180 vs. 3.2-1,297 ng/L, respectively.

Summary: Only the GFAP positive cut-off (255 ng/L) appears to be reliable. The negative COs appear unreliable.

Outlook: GFAP needs better standardization. However, the AUCs of the phospho-Tau and phospho-Tau/Tau proteins resulted not significantly lower than AUC of GFAP, but this result needs further verifications.

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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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