頭部外傷診療における血液バイオマーカーの役割
頭部外傷診療においては, 初診時に軽症であっても遅発性変化により重症化することがあり初期診療での対応が重要である. 頭部CT撮影の要否やフォローの方法などさまざまな決断が必要となる. 近年, ubiquitin C-terminal hydrolase-L1 (UCH-L1) やglial fibrillary acidic protein (GFAP) などの血液バイオマーカーを用いた脳損傷のスクリーニングや病態進行の予見が可能となった. この補助診断ツールは, 判定が簡便かつ明確であり有用である. また, スポーツ関連脳振盪や症状に乏しい高齢者頭部外傷におけるスクリーニングとしても, 今後...
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| Published in | 脳神経外科ジャーナル Vol. 29; no. 5; pp. 348 - 353 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.29.348 |
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| Abstract | 頭部外傷診療においては, 初診時に軽症であっても遅発性変化により重症化することがあり初期診療での対応が重要である. 頭部CT撮影の要否やフォローの方法などさまざまな決断が必要となる. 近年, ubiquitin C-terminal hydrolase-L1 (UCH-L1) やglial fibrillary acidic protein (GFAP) などの血液バイオマーカーを用いた脳損傷のスクリーニングや病態進行の予見が可能となった. この補助診断ツールは, 判定が簡便かつ明確であり有用である. また, スポーツ関連脳振盪や症状に乏しい高齢者頭部外傷におけるスクリーニングとしても, 今後の活用が期待されている. |
|---|---|
| AbstractList | 頭部外傷診療においては, 初診時に軽症であっても遅発性変化により重症化することがあり初期診療での対応が重要である. 頭部CT撮影の要否やフォローの方法などさまざまな決断が必要となる. 近年, ubiquitin C-terminal hydrolase-L1 (UCH-L1) やglial fibrillary acidic protein (GFAP) などの血液バイオマーカーを用いた脳損傷のスクリーニングや病態進行の予見が可能となった. この補助診断ツールは, 判定が簡便かつ明確であり有用である. また, スポーツ関連脳振盪や症状に乏しい高齢者頭部外傷におけるスクリーニングとしても, 今後の活用が期待されている. |
| Author | 藤山, 雄一 末廣, 栄一 清平, 美和 鈴木, 倫保 土師, 康平 |
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| References | 21) 鈴木倫保 : くも膜下出血治療に残された課題. 脳外誌 22 : 759-769, 2013. 17) Plog BA, Dashnaw ML, Hitomi E, Peng W, Liao Y, Lou N, Deane R, Nedergaard M : Biomarkers of traumatic injury are transported from brain to blood via the glymphatic system. J Neurosci 35 : 518-526, 2015. 9) Gardner RC, Rubenstein R, Wang KKW, Korley FK, Yue JK, Yuh EL, Mukherie P, Valadka AB, Okonkwo DO, Diaz-Arrastia R, Manley GT : Age-related differences in diagnostic accuracy of plasma glial fibrillary acidic protein and tau for identifying acute intracranial trauma on computed tomography : A TRACK-TBI study. J Neurotrauma 35 : 2341-2350, 2018. 1) Aspelund A, Antila S, Proulx ST, Karlsen TV, Karaman S, Detmar M, Wiig H, Alitalo K : A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules. J Exp Med 212 : 991-999, 2015. 5) Carlson AP, Ramirez P, Kennedy G, McLean AR, Murray-Krezan C, Stippler M : Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. Neurosurg Focus 29 : E3, 2010. 14) Ost M, Nylen K, Csajbok L, Ohrfelt AO, Tullberg M, Wikkelso C, Nellgard P, Rosengren L, Blennow K, Nellgard B : Initial CSF total tau correlates with 1-year outcome in patients with traumatic brain injury. Neurology 67 : 1600-1604, 2006. 22) Thelin EP, Nelson DW, Bellander BM : A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury. Acta Neurochir (Wien) 159 : 209-225, 2017. 3) Biomarkers Definitions Working Group : Biomarkers and surrogate endpoints : preferred definitions and conceptual framework. Clin Pharmacol Ther 69 : 89-95, 2001. 19) Suehiro E, Koizumi H, Fujiyama Y, Yoneda H, Suzuki M : Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury. Clin Neurol Neurosurg 127 : 97-100, 2014. 24) Vajtr D, Benada O, Kukacka J, Prusa R, Houstava L, Toupalik P, Kizek R : Correlation of ultrastructural changes of endothelial cells and astrocytes occurring during blood brain barrier damage after traumatic brain injury with biochemical markers of BBB leakage and inflammatory response. Physiol Res 58 : 263-268, 2009. 13) Mahan MY, Thorpe M, Ahmadi A, Abdallah T, Casey H, Sturtevant D, Judge-Yoakam S, Hoover C, Rafter D, Miner J, Richardson C, Samadani U : Glial fibrillary acidic protein (GFAP) outperforms S100 calcium-binding protein B (S100B) and ubiquitin C-terminal hydrolase L1 (UCH-L1) as predictor for positive computed tomography of the head in trauma subjects. World Neurosurg 128 : e434-e444, 2019. 15) Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H : GFAP versus S100B in serum after traumatic brain injury : relationship to brain damage and outcome. J Neurotrauma 21 : 1553-1561, 2004. 11) 日本蘇生協議会監 : JRC蘇生ガイドライン2015. 東京, 医学書院, 2016. 10) Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM : Indications for computed tomography in patients with minor head injury. N Engl J Med 343 : 100-105, 2000. 18) Shahim P, Tegner Y, Marklund N, Blennow K, Zetterberg H : Neurofilament light and tau as blood biomarkers for sports-related concussion. Neurology 90 : e1780-e1788, 2018. 26) Verschoof MA, Zuurbier CCM, de Beer F, Coutinho JM, Eggink EA, van Geel BM : Evaluation of the yield of 24-h close observation in patients with mild traumatic brain injury on anticoagulation therapy : a retrospective multicenter study and meta-analysis. J Neurol 265 : 315-321, 2018. 27) Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan ChA, Traubner P, Twijnstra A, Vecsei L, von Wild K, European Federation of Neurological Societies : EFNS guideline on mild traumatic brain injury : report of an EFNS task force. Euro J Neurol 9 : 207-219, 2002. 12) Joseph JR, Swallow JS, Willsey K, Lapointe AP, Khalatbari S, Korley FK, Oppenlander ME, Park P, Szerlip NJ, Broglio SP : Elevated markers of brain injury as a result of clinically asymptomatic high-acceleration head impacts in high-school football athletes. J Neurosurg 130 : 1642-1648, 2019. 2) Bazarian JJ, Biberthaler P, Welch RD, Lewis LM, Barzo P, Bogner-Flatz V, Gunnar Brolinson P, Büki A, Chen JY, Christenson RH, Hack D, Huff JS, Johar S, Jordan JD, Leidel BA, Lindner T, Ludington E, Okonkwo DO, Ornato J, Peacock WF, Schmidt K, Tyndall JA, Vossough A, Jagoda AS : Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI) : a multicentre observational study. Lancet Neurol 17 : 782-789, 2018. 28) Zemlan FP, Jauch EC, Mulchahey JJ, Gabbita SP, Rosenberg WS, Speciale SG, Zuccarello M : C-tau biomarker of neuronal damage in severe brain injured patients : association with elevated intracranial pressure and clinical outcome. Brain Res 947 : 131-139, 2002. 4) Büki A, Okonkwo DO, Wang KK, Povlishock JT : Cytochrome c release and caspase activation in traumatic brain injury. J Neurosci 20 : 2825-2834, 2000. 8) Folkerts MM, Berman RF, Muizelaar JP, Rafols JA : Disruption of MAP-2 immunostaining in rat hippocampus after traumatic brain injury. J Neurotrauma 15 : 349-363, 1998. 6) Costello DM, Kaye AH, O'Brien TJ, Shultz SR : Sport related concussion―Potential for biomarkers to improve acute management. J Clin Neurosci 56 : 1-6, 2018. 16) Petzold A : Neurofilament phosphoforms : surrogate markers for axonal injury, degeneration and loss. J Neurol Sci 233 : 183-198, 2005. 23) Tomita K, Nakada TA, Oshima T, Motoshima T, Kawaguchi R, Oda S : Tau protein as a diagnostic marker for diffuse axonal injury. PLoS One 14 : e0214381, 2019. 25) Vajtr D, Benada O, Linzer P, Samal F, Springer D, Strejc P, Beran M, Prusa R, Zima T : Immunohistochemistry and serum values of S-100B, glial fibrillary acidic protein, and hyperphosphorylated neurofilaments in brain injuries. Soud Lek 57 : 7-12, 2012. 7) de Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Twijnstra A : S-100B and neuron-specific enolase in serum of mild traumatic brain injury patients. A comparison with health controls. Acta Neurol Scand 103 : 175-179, 2001. 20) Sugimoto K, Suehiro E, Shinoyama M, Sadahiro H, Haji K, Fujiyama Y, Kawano R, Nishioka M, Suzuki M : D-dimer elevation as a blood biomarker for detection of structural disorder in mild traumatic brain injury. J Neurotrauma 34 : 3245-3248, 2017. |
| References_xml | – reference: 7) de Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Twijnstra A : S-100B and neuron-specific enolase in serum of mild traumatic brain injury patients. A comparison with health controls. Acta Neurol Scand 103 : 175-179, 2001. – reference: 6) Costello DM, Kaye AH, O'Brien TJ, Shultz SR : Sport related concussion―Potential for biomarkers to improve acute management. J Clin Neurosci 56 : 1-6, 2018. – reference: 21) 鈴木倫保 : くも膜下出血治療に残された課題. 脳外誌 22 : 759-769, 2013. – reference: 22) Thelin EP, Nelson DW, Bellander BM : A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury. Acta Neurochir (Wien) 159 : 209-225, 2017. – reference: 19) Suehiro E, Koizumi H, Fujiyama Y, Yoneda H, Suzuki M : Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury. Clin Neurol Neurosurg 127 : 97-100, 2014. – reference: 24) Vajtr D, Benada O, Kukacka J, Prusa R, Houstava L, Toupalik P, Kizek R : Correlation of ultrastructural changes of endothelial cells and astrocytes occurring during blood brain barrier damage after traumatic brain injury with biochemical markers of BBB leakage and inflammatory response. Physiol Res 58 : 263-268, 2009. – reference: 5) Carlson AP, Ramirez P, Kennedy G, McLean AR, Murray-Krezan C, Stippler M : Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. Neurosurg Focus 29 : E3, 2010. – reference: 26) Verschoof MA, Zuurbier CCM, de Beer F, Coutinho JM, Eggink EA, van Geel BM : Evaluation of the yield of 24-h close observation in patients with mild traumatic brain injury on anticoagulation therapy : a retrospective multicenter study and meta-analysis. J Neurol 265 : 315-321, 2018. – reference: 25) Vajtr D, Benada O, Linzer P, Samal F, Springer D, Strejc P, Beran M, Prusa R, Zima T : Immunohistochemistry and serum values of S-100B, glial fibrillary acidic protein, and hyperphosphorylated neurofilaments in brain injuries. Soud Lek 57 : 7-12, 2012. – reference: 3) Biomarkers Definitions Working Group : Biomarkers and surrogate endpoints : preferred definitions and conceptual framework. Clin Pharmacol Ther 69 : 89-95, 2001. – reference: 4) Büki A, Okonkwo DO, Wang KK, Povlishock JT : Cytochrome c release and caspase activation in traumatic brain injury. J Neurosci 20 : 2825-2834, 2000. – reference: 17) Plog BA, Dashnaw ML, Hitomi E, Peng W, Liao Y, Lou N, Deane R, Nedergaard M : Biomarkers of traumatic injury are transported from brain to blood via the glymphatic system. J Neurosci 35 : 518-526, 2015. – reference: 16) Petzold A : Neurofilament phosphoforms : surrogate markers for axonal injury, degeneration and loss. J Neurol Sci 233 : 183-198, 2005. – reference: 9) Gardner RC, Rubenstein R, Wang KKW, Korley FK, Yue JK, Yuh EL, Mukherie P, Valadka AB, Okonkwo DO, Diaz-Arrastia R, Manley GT : Age-related differences in diagnostic accuracy of plasma glial fibrillary acidic protein and tau for identifying acute intracranial trauma on computed tomography : A TRACK-TBI study. J Neurotrauma 35 : 2341-2350, 2018. – reference: 28) Zemlan FP, Jauch EC, Mulchahey JJ, Gabbita SP, Rosenberg WS, Speciale SG, Zuccarello M : C-tau biomarker of neuronal damage in severe brain injured patients : association with elevated intracranial pressure and clinical outcome. Brain Res 947 : 131-139, 2002. – reference: 13) Mahan MY, Thorpe M, Ahmadi A, Abdallah T, Casey H, Sturtevant D, Judge-Yoakam S, Hoover C, Rafter D, Miner J, Richardson C, Samadani U : Glial fibrillary acidic protein (GFAP) outperforms S100 calcium-binding protein B (S100B) and ubiquitin C-terminal hydrolase L1 (UCH-L1) as predictor for positive computed tomography of the head in trauma subjects. World Neurosurg 128 : e434-e444, 2019. – reference: 11) 日本蘇生協議会監 : JRC蘇生ガイドライン2015. 東京, 医学書院, 2016. – reference: 15) Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H : GFAP versus S100B in serum after traumatic brain injury : relationship to brain damage and outcome. J Neurotrauma 21 : 1553-1561, 2004. – reference: 14) Ost M, Nylen K, Csajbok L, Ohrfelt AO, Tullberg M, Wikkelso C, Nellgard P, Rosengren L, Blennow K, Nellgard B : Initial CSF total tau correlates with 1-year outcome in patients with traumatic brain injury. Neurology 67 : 1600-1604, 2006. – reference: 1) Aspelund A, Antila S, Proulx ST, Karlsen TV, Karaman S, Detmar M, Wiig H, Alitalo K : A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules. J Exp Med 212 : 991-999, 2015. – reference: 18) Shahim P, Tegner Y, Marklund N, Blennow K, Zetterberg H : Neurofilament light and tau as blood biomarkers for sports-related concussion. Neurology 90 : e1780-e1788, 2018. – reference: 23) Tomita K, Nakada TA, Oshima T, Motoshima T, Kawaguchi R, Oda S : Tau protein as a diagnostic marker for diffuse axonal injury. PLoS One 14 : e0214381, 2019. – reference: 12) Joseph JR, Swallow JS, Willsey K, Lapointe AP, Khalatbari S, Korley FK, Oppenlander ME, Park P, Szerlip NJ, Broglio SP : Elevated markers of brain injury as a result of clinically asymptomatic high-acceleration head impacts in high-school football athletes. J Neurosurg 130 : 1642-1648, 2019. – reference: 20) Sugimoto K, Suehiro E, Shinoyama M, Sadahiro H, Haji K, Fujiyama Y, Kawano R, Nishioka M, Suzuki M : D-dimer elevation as a blood biomarker for detection of structural disorder in mild traumatic brain injury. J Neurotrauma 34 : 3245-3248, 2017. – reference: 27) Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan ChA, Traubner P, Twijnstra A, Vecsei L, von Wild K, European Federation of Neurological Societies : EFNS guideline on mild traumatic brain injury : report of an EFNS task force. Euro J Neurol 9 : 207-219, 2002. – reference: 10) Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM : Indications for computed tomography in patients with minor head injury. N Engl J Med 343 : 100-105, 2000. – reference: 2) Bazarian JJ, Biberthaler P, Welch RD, Lewis LM, Barzo P, Bogner-Flatz V, Gunnar Brolinson P, Büki A, Chen JY, Christenson RH, Hack D, Huff JS, Johar S, Jordan JD, Leidel BA, Lindner T, Ludington E, Okonkwo DO, Ornato J, Peacock WF, Schmidt K, Tyndall JA, Vossough A, Jagoda AS : Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI) : a multicentre observational study. Lancet Neurol 17 : 782-789, 2018. – reference: 8) Folkerts MM, Berman RF, Muizelaar JP, Rafols JA : Disruption of MAP-2 immunostaining in rat hippocampus after traumatic brain injury. J Neurotrauma 15 : 349-363, 1998. |
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| Snippet | 頭部外傷診療においては, 初診時に軽症であっても遅発性変化により重症化することがあり初期診療での対応が重要である. 頭部CT撮影の要否やフォローの方法などさまざまな決断が必要となる. 近年, ubiquitin C-terminal hydrolase-L1 (UCH-L1) やglial fibrillary... |
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| Title | 頭部外傷診療における血液バイオマーカーの役割 |
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