Petzold Axel
The Tavistock Intensive Care Unit, Department of Neuroimmunology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK.
Neurol Res. 2007 Oct;29(7):691-708. doi: 10.1179/016164107X240080.
Providing an accurate prognosis in patients suffering from acute central nervous system (CNS) disease is difficult. The extent and location of the primary CNS injury is crucial for mortality and morbidity. Secondary injury adds considerably to the CNS insult. The prognosis in an individual patient depends on the combination of primary and secondary CNS damage together with systemic complications. The clinical challenge of an accurate prognosis is therefore aided by both quantitative techniques, able to estimate the degree of CNS damage and qualitative techniques, which identify the site of the lesion. Here the contribution of cerebrospinal fluid (CSF) biomarkers to improving the prognostic accuracy is reviewed. First, current definitions in biomarker research are introduced. Second, the role of the blood-brain barrier (BBB) is discussed. Third, the physiologic and anatomical constraints of the CSF are summarized. Fourth, following an overview on CSF biomarkers, cell type-specific CSF biomarkers and more global CSF biomarkers for parenchymal CNS damage are reviewed in detail. The release of these biomarkers from dying cells is illustrated by a video of a laser-dissected neuron. Finally, the evidence for improving prognostic accuracy is summarized and recommendations are made for future biomarker research.
对患有急性中枢神经系统（CNS）疾病的患者提供准确的预后评估很困难。原发性中枢神经系统损伤的范围和位置对死亡率和发病率至关重要。继发性损伤会显著加重中枢神经系统的损害。个体患者的预后取决于原发性和继发性中枢神经系统损伤以及全身并发症的综合情况。因此，能够估计中枢神经系统损伤程度的定量技术和识别病变部位的定性技术都有助于应对准确预后这一临床挑战。本文将综述脑脊液（CSF）生物标志物对提高预后准确性的贡献。首先，介绍生物标志物研究中的当前定义。其次，讨论血脑屏障（BBB）的作用。第三，总结脑脊液的生理和解剖学限制。第四，在对脑脊液生物标志物进行概述之后，将详细综述针对实质性中枢神经系统损伤的细胞类型特异性脑脊液生物标志物和更具全局性的脑脊液生物标志物。通过激光切割神经元的视频展示了这些生物标志物从垂死细胞中的释放。最后，总结提高预后准确性的证据，并对未来生物标志物研究提出建议。
