Der Nervenarzt

, Volume 85, Issue 8, pp 982–989 | Cite as

Saures Gliafaserprotein beim Patienten mit akuten Schlaganfallsymptomen

Diagnostischer Marker einer Hirnblutung
  • C. Foerch
  • W. Pfeilschifter
  • P. Zeiner
  • R. Brunkhorst
Originalien

Zusammenfassung

Das saure Gliafaserprotein („glial fibrillary acidic protein“, GFAP) ist ein hirnspezifisches Protein, das in Astrozyten in größeren Mengen exprimiert wird und wichtige Funktionen im Rahmen der Aufrechterhaltung des Zytoskeletts übernimmt. Nekrose und Zytolyse von astroglialen Zellen führen zur Freisetzung von GFAP in den Extrazellularraum und ins Blut. Hirnblutungen bedingen die unmittelbare mechanische Zelldestruktion, während bei Hirninfarkten Nekrose und Zytolyse histopathologisch in relevantem Ausmaß erst 6–12 h nach Symptombeginn zu finden sind. Insofern öffnet sich ein diagnostisches Fenster in den ersten Stunden nach dem Auftreten einer Schlaganfallsymptomatik, in dem erhöhte GFAP-Werte im Blut eine intrazerebrale Blutung anzeigen könnten. Diese Übersichtsarbeit beschreibt die dem Testprinzip zugrunde liegende Pathophysiologie und fasst die wesentlichen Ergebnisse der relevanten Forschungsarbeiten zusammen. Potenzielle Implikationen des GFAP-Tests wären die verbesserte prähospitale Triage von akuten Schlaganfallpatienten sowie die Möglichkeit, bei Patienten mit akuten Hirnblutungen rasch eine Therapie (Blutdrucksenkung, Gerinnungsausgleich bei antikoagulanzienassoziierter Blutung) einleiten zu können. Anderweitige mögliche Einsatzgebiete für GFAP liegen im Bereich der traumatischen Hirnschädigung und beim Glioblastom.

Schlüsselwörter

Hirninfarkt Schädel-Hirn-Trauma Glioblastom Blutdruck Prädiktiver Wert von Tests 

Glial fibrillary acidic protein in patients with symptoms of acute stroke

Diagnostic marker of cerebral hemorrhage

Summary

Glial fibrillary acidic protein (GFAP) is a highly brain-specific protein that is expressed in large quantities in astrocytes and has important functions in terms of maintaining and stabilizing the cytoskeleton. Acute intracerebral hemorrhage leads to an immediate mechanical destruction of astroglial cells with the subsequent release of GFAP into the extracellular space and the bloodstream. On the other hand, necrosis, cytolysis and GFAP release does not occur before 6–12 h after symptom onset in ischemic stroke. Thus, in the early hours after stroke increased GFAP values could indicate intracerebral hemorrhage. This review article describes the underlying pathophysiology of the test and guides the reader through the available data. Potential implications regarding the prehospital triage of acute stroke patients are discussed, including the possibility to initiate hyperacute treatment, such as blood pressure reduction in patients with intracerebral hemorrhage. Other areas of interest for a potential GFAP test include traumatic brain injury and malignant gliomas.

Keywords

Ischemic stroke Traumatic brain injury Glioblastoma Blood pressure Predictive value of tests 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Foerch hat an vergüteten Advisory Boards der Fa. Roche Diagnostics zum Thema GFAP teilgenommen. Er hat Forschungsmittel der Fa. Roche Diagnostics für GFAP-Studien erhalten und ist Miterfinder des Patentes „Use of GFAP for identification of intracerebral hemorrhage“.W. Pfeilschifter, P. Zeiner und R. Brunkhorst geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • C. Foerch
    • 1
  • W. Pfeilschifter
    • 1
  • P. Zeiner
    • 1
  • R. Brunkhorst
    • 1
  1. 1.Klinik für NeurologieKlinikum Goethe-UniversitätFrankfurt am MainDeutschland

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