Jensen Matthew B, Chacon Marcus R, Sattin Justin A, Aleu Aitziber, Lyden Patrick D
Department of Neurology, University of Wisconsin, Madison, WI 53792, USA.
Neurologist. 2008 Jul;14(4):243-6. doi: 10.1097/NRL.0b013e31815a9945.
Ischemic stroke and transient ischemic attack can be difficult to diagnose clinically, and both acute and preventive therapies carry some risk. Serum biomarkers could increase diagnostic certainty by helping to distinguish cerebral ischemia from common mimics such as focal seizure, complicated migraine, and psychogenic spells. Biomarkers could also identify patients at high risk for future vascular events, which would aid in management decisions.
There are many potential obstacles to finding these biomarkers, which are reviewed here, including the blood brain barrier, confounding by other conditions, and imperfect gold standards for use in validation. Diagnostic biomarkers are likely to be molecules found predominantly in brain tissue with rapid entry into the blood, whereas risk-stratification biomarkers may be related to the concept of an active atherosclerotic plaque. Many promising serum molecules have been examined in small series of patients with cerebrovascular disease.
Large series examining many candidate molecules will be needed to find valid biomarkers, and this should be followed by use in future intervention trials to prove their utility.
缺血性中风和短暂性脑缺血发作在临床上可能难以诊断，并且急性和预防性治疗都有一定风险。血清生物标志物有助于区分脑缺血与常见的类似病症，如局灶性癫痫、复杂性偏头痛和心因性发作，从而提高诊断的确定性。生物标志物还可以识别未来发生血管事件的高危患者，这将有助于做出管理决策。
寻找这些生物标志物存在许多潜在障碍，本文对此进行了综述，包括血脑屏障、其他病症的干扰以及用于验证的不完善金标准。诊断性生物标志物可能是主要存在于脑组织中且能迅速进入血液的分子，而风险分层生物标志物可能与活跃动脉粥样硬化斑块的概念有关。许多有前景的血清分子已在少量脑血管疾病患者中进行了检测。
需要进行大量研究以检测众多候选分子来找到有效的生物标志物，随后应在未来的干预试验中使用这些生物标志物以证明其效用。
