| Objective: Nerve biochemical detection provide an effective method to judge the clinical prognosis to head injury patiens. The study on the nerve-biochemical marker has appeal to the eye of researchers recently, with the common objective finding the acute.non-invasive index that can reflect the scope and prognosis of central nerve system. Some reachers have found some biochemical markers that can judge the injury limit and prognosis through the study of blood and CSF. At the same time, they found some biochemical markers even surpass CT and MRI et al imageology scopy in earlier period. Such markers include some proteins, enzyme, cytokines and neurotransmitter et al. Glial fibrillary acidic protein (GFAP) is a kind of index needing detedted when the head injury happened. We want to definite the usage of the marker on the diagnosis and prognosis of head injury through detecting the changes of its concentration in peripherial blood of head injury patients. Detecting the expression level of head tissue to those patients needing operation, definite if the expression level of head tissue concord to the level in peripherial blood. At the same time, the sensitivity and specificity to judge the prognosis of head injury (HI)were definited.Methods: 1. Divided the 80 rats into 10 groups randomly , as the group of nomal control, 1d after injury, 7d after injury, 14d after injury, control with SB203580 (A special inhibitor of P38MAPK), 1d 1d after injury with SB203580, 7d after injury with SB203580, 14d after injury with SB203580. Then detech the content of protein GFAP and P38MAPK by the method of western blot.2. All objects recruited were examed by head CT to testify contusion and laceration of brain, scored with GCS system, all those severe combined injury ; auto-immune disease; malignant tumor; heametology disease and severe infection were removed. Operation group and non-operation group were divided according if operation was undertaked, dividing the patients into gently; meddle and severe groups according the head injury extent. The peripherial blood was detected in the patients without operation at 4h,6h,8h,12h,16h,24h,48h after in-patient,but at 2h,4h,8h,24h before and after operation to those patients undertaking the operation. Other detection such as the expression of GFAP in cerebral tissue was executed to those operation patients. At the same time, MAP,ICP,CCP need to be monitored to severe head injury. Calculate the relationship between GFAP and the MAP,ICP,CCP,prognosis. hyperthermy ,acute cardiogenic oedema pulmonum, hyperglykemia originated from diabetes. gastrorrhagia from ulcer, senile dementia, inflammation of the central nervous system, epilepsy, migraine and dementia praecox patients were recruited as pathology control group. Healthy objects recruited as health control group.Resluts: GFAP concentration in peripherial blood after head injury show significant difference with health control group (p<0.05). The peak concentration of GFAP is 48h after head injury to those no-operation patients. The concentration of GFAP decreases gradually after operation. Those patients who decreasing of such indexes is not obviously indicate the bad prognosis. the concentration of GFAP in peripherial blood show significant difference with fever,edema of lung,high hyperglycaemia, gastrorrhagia patients(p<0.05). The concentration of GFAP in peripherial blood of senile dementia , inflammation of the central nervous system, epilepsy, migraine and dementia praecox patients show no difference with health objects (p>0.05). The concentraion of peripherial blood, the expression of brain tissue of GFAP is higher in ICP<25 mmHg, MAP<60 mmHg, CCP<60 mmHg patients than ICP≥25 mmHg, MAP≥60 mmHg, CCP≥60 mmHg patients. The concentration GFAP show obviously relationship with prognosis(r=0.915, p<0.05),the more high of The concentration of GFAP when hospital admission, the more bad of the prognosis.conclusions: The concentration of GFAP increased both in peripherial blood and injury tissues in patients and experimental rats afer head injury. For patients, the more high of the concentration of GFAP when hospital admission, the more bad of the prognosis, and the concentration GFAP show obviously relationship with prognosis. GFAP up-regulation after HI may mainly through the pathway of P38MAPK signal. Comparing with other nerve-biochemical markers, GFAP increasing slowly and persistently. The sensitivity for deteching may inferior to other markers as GFAP up-regulation was not so fast as other matkers (for example NES) in early period of HI. If combine with other nerve-biochemical markers, GFAP level will assit to diagnosis head injury and judge the condition of prognosis. |
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