Dynamic Change And Clinical Significance Of Endostatin Levels Of Cerebrospinal Fluid In Patients With Severe Traumatic Brain Injury

Background Cerebral ischemia and hypoxia are the most common secondary injuries following severe traumatic brain injury and have a direct impact on the prognosis of the patients. Angiogenesis is an important pathophysiological response to trauma and ischemia and modulated by pro-angiogenic and antiangiogenic factors. It can accelerate the establishment of collateral circulation in the ischemic regions to increase the local blood flow, and promote neurofunctional repair by remodeling the structure of injured tissues. Increased expression of pro-angiogenic factors in blood has been detected in patients with traumatic brain injury, but fewer studies have focused on the expression of antiangiogenic factors after traumatic brain injury. Recent experimental studies have suggested that endostatin (ES) might play an important role in the secondary brain injury and angiogenesis following traumatic brain injury.Objective To explore the dynamic change of cerebrospinal fluid (CSF) endostatin in patients with severe traumatic brain injury and its clinical significance.Methods ES levels were measured serially for one week after hospitalization by using the enzyme linked immunosorbent assay (ELISA) method in the CSF of 30 patients with severe traumatic brain injury, and comparative analysis combined with GCS scores on admission and the short-term and long-term prognosis of the patients were performed. ROC curve was used to appraise the value of CSF ES levels in predicting the prognosis of patients with severe head injury.Results Compared with the normal control group, the CSF levels of ES in the patients with severe head injury increased obviously on day 3, 5 and 7 after trauma (P<0.05, P<0.01, P<0.01, respectively). CSF ES levels on day 3 and 5 after injury of patients with GCS scores of 3～5 were significantly higher than those with GCS scores of 6～8 (P<0.05). CSF ES levels on day 3 and 5 after trauma of the patients who died at 1 month after trauma were significantly higher than the survivals (P<0.05, P<0.01, respectively). Compared with the better prognosis group at 6 months after injury, the CSF levels of ES on day 5 and 7 after injury were significantly higher in poorer prognosis groups (P<0.05, P<0.01, respectively). ROC curve analysis suggested that CSF ES levels on day 5 and 7 after injury had predictive values in the short-term and long-term prognosis of patients with severe head injury. The best threshold values were≥86.72 pg/ml and≥67.29 pg/ml, respectively.Conclusion ES levels in CSF of patients with severe traumatic brain injury increased obviously within 1 week after injury, and its dynamic change may have some clinical significance on the judgment of brain injury severity and the assessment of prognosis.