弥漫性轴索损伤的诊断、预后评估和治疗进展

Research progress in diagnosis, prognostication and treatment of diffuse axonal injury

创伤性脑损伤(TBI)是常见而复杂的一种创伤。如患者头部遭受钝性加速/减速暴力,可导致广泛的白质轴索损伤,即所谓弥漫性轴索损伤(DAI)。DAI影响神经环路的功能,是TBI患者出现认知、行为和情感障碍的重要原因。目前,DAI的诊断、预后评估及治疗仍是一个临床难题。越来越多的证据表明,神经影像学如MRI可检出不同严重程度DAI患者细微或明显的白质病变。另一方面,轴索损伤的外周血生物标志物在DAI的临床评估中发挥着愈加重要的作用。此外,DAI治疗相关临床研究的新成果亦值得关注。笔者就近期DAI无创诊断、预后评估及治疗的研究进展作一综述,以期为进一步临床研究提供参考。

Traumatic brain injury(TBI)is a common and complex form of trauma.If inertial acceleration/deceleration forces are transmitted to the head,widespread injury to axons may happen,which is also known as diffuse axonal injury(DAI).DAI leads to neural network dysfunction,and contributes to cognitive,behavioral and emotional impairments frequently observed in TBI patients.The diagnosis,prognosis and treatment of DAI remains a challenging clinical entity.Growing evidence demonstrate that neuroimaging modalities such as MRI can detect subtle or overt white matter lesions in DAI patients with all severities of injury.Moreover,peripheral blood biomarkers gain an emerging role in the clinical evaluation of axonal injury.As for treatment of DAI,the new clinical results are also worthy of attention.The authors aim to briefly summarize the recent advancements concerning non-invasive diagnosis,prognostication and treatment of DAI,which may shed light on further clinical studies.