Clinical Significance Of Serum GFAP In The Diagnosis And Prognosis Of Patients With Mild Craniocerebral Injury

Objective: To explore the clinical significance of serum GFAP in the diagnosis and prognosis of patients with mild craniocerebral injury,to promote the clinical understanding of mild craniocerebral injury,and to improve the prognosis of patients with mild craniocerebral injury.Methods: Enzyme linked immunosorbent assay(ELISA)was used to detect the serum GFAP content of 74 patients with mild craniocerebral injury admitted to our neurosurgery from July 2018 to July 2019,and compared with 15 healthy patients and 14 patients with clear traumatic history,but no traumatic history.To evaluate the relationship between serum GFAP level and GCS score,CT manifestations,severity of clinical symptoms(chief complaint headache)and cos-e score six months after injury.Results: 1.There was no statistically significant difference in serum GFAP concentrations between patients with a history of trauma but no history of traumatic brain injury and patients with a healthy physical examination(P = 0.681),but the serum GFAP concentration increased in patients with mild traumatic brain injury(P < 0.05);2.There was no statistically significant difference in serum GFAP concentration between patients with skull fracture and patients without skull fracture in mild traumatic brain injury with negative CT(P =0.480),There was a statistically significant difference in serum GFAP concentration between patients with head CT positive and those with head CT negative mild traumatic brain injury(P < 0.05),Combined with ROC curve analysis,it is suggested that serum GFAP concentration has a high accuracy(AUC = 0.993,95% CI 0.982-1)in judging whether light head injury patients have brain parenchyma injury(CT positive).3.The serum GFAP concentration of patients with mild traumatic brain injury with GCS score of 13 and 14 was statistically different from that of patients with mild traumatic brain injury with GCS score of 15(P < 0.05),but there was no statistically significant difference between the patients with mild traumatic brain injury with 13 and 14 scores(P = 0.217).Combined with ROC curve analysis,it was suggested that the serum GFAP concentration of the patients with mild traumatic brain injury had a certain accuracy(AUC=0.736,95% CI 0.617-0.856)in judging whether the patients had consciousness disorder(the GCS score is reduced,and the GCS score is 13 or 14).4.The serum GFAP concentration of patients with mild traumatic brain injury graded by VRS method grade II and VRS grade III were statistically significant compared with the patients with mild brain injury graded by VRS method grade 0-I(P< 0.05).but there was no statistically significant difference between the patients with mild traumatic brain injury with grade II and grade III of VRS(P = 0.876),Combined with ROC curve analysis,it is suggested that serum GFAP concentration has a high accuracy(AUC= 0.932,95% CI 0.857-1)in judging whether patients with mild traumatic brain injury have severe headache(intolerable,requiring analgesic treatment,VRS classification is level II or level III).5.We followed up the GOS-E scores of patients with mild traumatic brain injury after 6 months by telephone,36 of them indicated poor prognosis,38 showed good prognosis,and 48.6% of them had poor prognosis.ROC curve analysis showed that serum GFAP concentration had a certain accuracy in judging the prognosis of patients(AUC= 0.716,95% CI 0.857-1),Combined with the analysis of youden index,it was suggested that the prognosis was poor when the serum GFAP concentration was? 0.665 ?g/L at admission(the accuracy was 71.6%).Conclusion: Serum GFAP has a certain specificity to distinguish whether there is mTBI in patients.It can be better used in the auxiliary diagnosis of mTBI.It is another mTBI auxiliary examination index in addition to brain MRI,CT and other image examinations.It can make up for the shortcomings of low positive rate of brain CT for MTBI;To some extent,the change of serum GFAP concentration in clinical diagnosis and treatment can reflect the change of GCS score and the severity of clinical symptoms(chief complaint headache)of patients with mTBI,and guide clinical work;In addition,GFAP can be used as a serological index to judge the prognosis of mTBI.When the serum GFAP concentration? 0.665 ?g/L in patients with mTBI at admission,we need to pay more attention to it,suggesting that the patients may have poor prognosis.