Explore The Clinical Application Of Cerebrospinal Fluid Markers In The Diagnosis And Treatment Of Idiopathic Normal Pressure Hydrocephalus

Purpose:To investigate the clinical significance of phosphorylated tau protein(p-tau),total tau protein(t-tau),transforming growth factor ? 1(TGF-?1)in the early diagnosis,the prediction of the effectiveness of shunt operation and the judgement of the operative effect of idiopathic normal pressure hydrocephalus(iNPH).Methods:From June 2018 to February 2020,16 patients with iNPH confirmed after operation in the Second Affiliated Hospital of Nanchang University were selected.Meanwhile,16 patients with suspected clinical iNPH who were invalid by the cerebrospinal fluid release Test(TT)were performed,and the CSF in the TT was collected from two groups of patients.At the same time,8 cases of iNPH confirmed to be effective by cerebrospinal fluid shunt operation were selected to collect CSF before and after operation.Then,the concentration of p-tau,t-tau and TGF-?1 in CSF from each group were detected by Enzyme-linked immunosorbent assay method(ELISA),and the significance of CSF biomarkers in iNPH diagnosis and treatment in each group was analyzed.Results:Among the clinically suspicious NPH patients at admission,the concentration of p-tau in the effective group(28.25 ± 7.88 pg/ml)was significantly lower than that in the ineffective group(56.89 ± 18.93 pg/ml)(P = 0.00);the concentration of t-tau in the effective group(372.5 ± 292.6 pg/ml)was slightly lower than that in the ineffective group(468.8 ± 159.2 pg/ml)(P = 0.256);the concentration of TGF-?1(952.5 ± 238.7 pg/ml)was higher than that of the ineffective group(581.4 ± 71.6pg/ml),but there was significant difference(P = 0.00).Among the clinically confirmed iNPH patients,the concentration of p-tau in the postoperative group was19.85 ± 4.02 pg/mL,lower than that in the preoperative group(27.86 ± 8.40 pg/ml),and the difference was statistically significant(P = 0.029).The t-tau concentration of the postoperative group was 141.8 ± 85.9 pg/mL,which was significantly lower than that of the preoperative group(457.1 ± 385.5 pg/ml),and the difference was statistically significant(P = 0.040).The concentration of TGF-?1 was 1077.2 ± 88.9pg/ml,higher than that in the preoperative group(943.3 ± 267.8 pg/ml),with no statistically significant difference(P = 0.214).Conclusion:1.P-tau has definite value in the early diagnosis of patients with iNPH,in the evaluation of the effectiveness of shunt operation and in the judgment of the effect and prognosis of patients with iNPH;t-tau has a certain significance in determining the surgical effect and prognosis of iNPH patients,but it has no definite value in early diagnosis of iNPH patients and evaluation of the effectiveness of shunt surgery;TGF-?1 has clear value in early diagnosis of iNPH patients and evaluation of the effectiveness of patient shunt surgery,while limited value in the evaluation of the surgical effect of patients.2.P-tau,t-tau and TGF-?1 have unique clinical application value in the diagnosis and treatment of iNPH.The concentration of p-tau and TGF-?1 in the effective group CSF were 28.25 ± 7.88 pg/mL and 952.5 ± 238.7 pg/mL respectively,which may provide some data reference for its clinical application in the future.3.Although iNPH lacks clear pathological characteristics,the changes of various biomarkers in CSF of iNPH patients can reflect the neuropathological characteristics of iNPH to a certain extent by comparative analysis.