颅脑创伤后的病理生理改变及相关生化标记物研究进展

Research of pathophysiological and biochemical markers in traumatic brain injury

颅脑创伤后脑组织存在一系列损伤,包括:脑挫裂伤,特定脑区的轴突损伤,脑水肿和出血等。由于不同患者细胞损伤程度、基因及内环境因素不同,脑损伤后患者的临床症状和预后各不相同。因此如何对患者进行准确评估、制定合适的治疗和康复计划、与患者家属进行沟通以及预测患者预后是临床工作中的一大难点。近年来越来越多的研究根据脑外伤后体液中标记物的浓度对患者进行评估。通过这些标记物可以有效地了解细胞代谢、生化及微环境的改变等,有效评估脑组织损伤程度。尽管有大量相关的研究报道,但在动物颅脑损伤模型中监测生化标记物的诊断和预后价值仍存在疑问。最近有研究提出将多种生化标记物与其他手段(影像学检查、预后评估量表和基因多态性)相结合可以更好地评估患者预后。越来越多的研究在临床随机对照研究中将生化标记物作为治疗监测和预后评估的手段。本文将对成人颅脑创伤后有关生化标记物的最新研究进行综述,讨论对患者评估的最新进展。

Traumatic brain injury is a multifaceted condition that encompasses a spectrum of injuries:contusions,axonal injuries in specific brain regions,edema,and hemorrhage.Brain injury determines a broad clinical and disability spectrum due to the implication of various cellular pathways,genetic phenotypes,and environmental factors.It is challenging to predict patient outcomes,to appropriately evaluate the patients,to determine a suitable treatment strategy and rehabilitation program,and to communicate with patient relatives.Biomarkers detected from body fluids are potential evaluation tools for traumatic brain injury patients.These may serve as internal indicators of cerebral damage,delivering valuable information about the dynamic cellular,biochemical,and molecular environments.The diagnostic and prognostic value of biomarkers tested both in animal models of traumatic brain injury is still under question,despite a considerable scientific literature.Recent publications emphasize that a more realistic approach involves combining multiple types of biomarkers with other investigative tools(imaging,outcome scales,and genetic polymorphisms).Additionally,there is increasing interest in the use of biomarkers as tools for treatment monitoring and as surrogate outcome variables to facilitate the design of distinct randomized controlled trials.This review highlights the latest available evidence regarding biomarkers in adults after traumatic brain injury and discusses new approaches in the evaluation of this patient group.