创伤性颅脑损伤后血清GFAP蛋白的变化与伤情及预后的Meta分析

目的评价血清胶质纤维酸性蛋白(GFAP)表达水平与创伤性颅脑损伤(TBI)伤情及预后的关系。方法通过计算机检索PubMed、EBSCO、Web of Science、Springer、Science director、ACS、ProQuest、TaylorFrancis、中国学术期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数据知识服务平台。设定文献纳入和排除标准,提取文献资料中死亡风险优势比(odds ratio,OR)作为主要评价指标,采用Revman 5.0软件进行Meta分析,探讨创伤性颅脑损伤(TBI)与GFAP的关系。结果符合条件的文献有16篇,其中正常对照组患者753例,TBI患者1 149例。Meta分析结果显示:(1)GFAP表达量与Marshall CT分级(OR=-5.44,95%CI=-7.07~-3.82,P0.01)、TBI程度(OR=-3.47,95%CI=-3.52~-3.41,P0.01)、TBI类型(OR=3.19,95%CI=2.51~3.88,P0.01)、格拉斯哥预后评分(GOS评分)(OR=2.78,95%CI=2.76~2.81,P0.01)、生存与否(OR=-1.66,95%CI=-2.35~-0.97,P0.01)有关。(2)GFAP表达与时间间隔具有相关性,与72h表达量(OR=-0.09,95%CI=-0.46~0.28,P0.01)和7d表达量(OR=2.51,95%CI=2.03~3.05,P0.01)均相关。结论 GFAP蛋白表达水平与TBI的伤情严重程度和预后均具有相关性。

Correlation of GFAP expression with injury severity and prognosis following traumatic brain injury: Meta analysis

Objective To investigate the relationship between the expression of glial fibrillary acidic protein (GFAP) and the traumatic condition and prognosis of traumatic brain injury (TBI).Methods Reference databases including PubMed,EBSCO,Web of Science,Springer,Science Director,ACS,ProQuest,Taylor & Francis,CNKI,VIP and Wanfang were searched,the inclusion criteria and exclusion criteria of literature were set.The outcome was measured using the odds ratio(OR) and inclusion literature was analyzed by Revman 5.0 software.Results Sixteen references were qualified,with 753 cases in the control group and 1149 cases in the TBI group.Meta analysis results showed that: (1) The GFAP expression was related to Marshall CT classification (OR=-5.44,95%CI=-7.07~-3.82,P<0.01),TBI degree (OR=-3.47,95%CI=--3.52~-3.41,P<0.01),type of TBI (OR=3.19,95%CI=2.51~3.88,P<0.01),GOS score (OR=2.78,95%CI=2.76~2.81,P<0.01),and survived or not (OR=-1.66,95%CI=-2.35~-0.97,P<0.01).(2) The GFAP expression was related with time lapse,including 72h (OR=-0.09,95%CI=-0.46~0.28,P<0.01),7d(OR=2.51,95%CI=2.03~3.05,P<0.01).Conclusion The expression of GFAP was relevant with the traumatic condition and prognosis of TBI.