Dynamiczne markery biologiczne do przewidywania epilepsji pourazowej po urazach głowy
DYNAMIC BIOMARKERS FOR PREDICTING POST-TRAUMATIC EPILEPSY AFTER TRAUMATIC BRAIN INJURY
W skrócie
Badanie pokazuje, że u pacjentów, którzy rozwali drgawki lub epilepsję po urazach głowy, znajduje się podwyższone stężenie specjalnych białek we krwi przez długi czas po urazie. Naukowcy zidentyfikowali pięć kluczowych białek, które można mierzyć, aby wcześnie rozpoznać pacjentów zagrożonych epilepsją pourazową. Prosty test laboratoryjny zwany BioIndex, oparty na trzech z tych białek, może pomóc lekarzom w następujących miesiącach po urazie przewidzieć, kto będzie miał problemy z drgawkami.
Oryginalny abstract (angielski)
BACKGROUND: Post-traumatic epilepsy (PTE) is a delayed complication of traumatic brain injury (TBI), but its biological predictors remain insufficiently defined. This study evaluated the dynamic profile of serum biomarkers of neuroinflammation, neuroimmune activation and neuronal injury after moderate TBI, as well as their predictive value for late post-traumatic seizures and PTE during 12 months of follow-up. MATERIALS AND METHODS: This prospective observational study included 126 patients with moderate TBI, who were classified at 12 months into patients without late post-traumatic seizures (n=113) and patients with late post-traumatic seizures or PTE-spectrum outcomes (n=13). The biomarker panel included interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL) and high-mobility group box 1 (HMGB1), measured at 24-48 hours, 7-10 days, 30±7 days and 3 months after injury. ROC analysis was used to determine clinically informative thresholds, and a composite BioIndex was calculated from IL-6, HMGB1 and NfL. RESULTS: Patients who developed late post-traumatic seizures or PTE-spectrum outcomes had significantly higher levels of inflammatory, neuroimmune and neuroinjury biomarkers throughout follow-up. IL-6, TNF-alpha and IL-1beta remained elevated from the acute phase to 3 months; GFAP and NfL indicated persistent astroglial and axonal injury; and HMGB1 reflected sustained neuroimmune activation. Clinically significant thresholds were IL-6≥10 pg/mL, IL-1beta≥2.0 pg/mL, TNF-alpha≥7.5 pg/mL, HMGB1≥6.0 ng/mL and NfL≥35 pg/mL. BioIndex≥2 was associated with an increased 12-month risk of late seizures or PTE-spectrum outcomes. CONCLUSION: Late post-traumatic seizures and PTE after moderate TBI are associated with a persistent biomarker signature of neuroinflammation, neuroimmune activation and glial-axonal injury. A simple BioIndex based on IL-6, HMGB1 and NfL may serve as a practical laboratory tool for early risk stratification and individualized follow-up after moderate TBI.