As excitatory neurotransmitters, glutamic acid (Glu) and aspartic acid (Asp) may play a key role in the pathological process of traumatic spinal cord injury. The purpose of this study was to investigate the dynamic changes of Glu and Asp concentrations in blood and spinal fluid of patients with secondary spinal cord injury and their correlation with prognosis, so as to provide evidence for disease monitoring and treatment. In this study, 62 patients with secondary spinal cord injury admitted from January 2021 to December 2023 were selected as study subjects. Blood and spinal fluid samples were collected at 1, 3, 7, 14, and 28 days after injury, and the concentrations of Glu and Asp were determined by high-performance liquid chromatography. At the same time, the neurological functions of the patients at admission and 3 months after injury were evaluated using the American Spinal Cord Injury Association (ASIA) scoring criteria, and the patients were divided into a good prognosis group (ASIA score increased by ≥10 points) and a poor prognosis group (ASIA score increased by <10 points). Repeated measurement ANOVA was used to compare the differences of Glu and Asp concentrations in blood and spinal fluid of patients and the control group at different time points, and Spearman correlation analysis was used to explore the correlation between Glu and Asp concentrations and changes in ASIA score. Logistic regression analysis was performed to determine the risk factors affecting the prognosis of patients, and a receiver operating characteristics (ROC) curve was drawn to evaluate the diagnostic value of relevant indicators for prognosis. The concentrations of Glu and Asp in blood and spinal fluid of patients with poor prognosis were higher than those of patients with good prognosis at all time points ( p < 0.05). The concentrations of Glu and Asp in blood and spinal fluid of patients with poor prognosis were higher than those of patients with good prognosis at all time points ( p < 0.05). Spearman correlation analysis showed that Glu and Asp concentrations in blood and spinal fluid were significantly negatively correlated with ASIA score (r = −0.65, p < 0.01; r = −0.58, p < 0.01). Logistic regression analysis showed that Glu concentration (OR = 2.58, 95% CI: 1.56–4.29) and Asp concentration (OR = 2.25, 95% CI: 1.32–3.84) in spinal fluid 7 days after injury were independent risk factors for prognosis. ROC curve showed that the area under the curve of the combined detection of Glu and Asp in spinal fluid at 7 days after injury was significantly higher than that of single index ( p < 0.01). The concentrations of Glu and Asp in the blood and spinal fluid of patients with acute traumatic spinal cord injury increase first and then decrease, and are closely related to the prognosis of patients. Early monitoring of these neurotransmitter concentrations after injury is helpful to evaluate the prognosis of patients and provide a reference for the formulation of personalized treatment plans. ROC curve analysis further clarified the diagnostic efficacy of relevant indicators in prognostic judgment.
Zhang et al. (Tue,) studied this question.