Sandler Simon J I, Figaji Anthony A, Adelson P David
Division of Neurosurgery, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa.
Childs Nerv Syst. 2010 Feb;26(2):205-13. doi: 10.1007/s00381-009-1009-1. Epub 2009 Nov 10.
The diagnosis, treatment, and prediction of outcome in pediatric traumatic brain injury (TBI) present significant challenges to the treating clinician. Clinical and radiological tools for assessing injury severity and predicting outcome, in particular, lack sensitivity and specificity. In patients with mild TBI, often there is uncertainty about which patients should undergo radiological imaging and who is at risk for long term neurological sequelae. In severe TBI, often there is uncertainty about which patients will experience secondary insults and what the outcome for individual patients will be. In several other clinical specialties, biomarkers are used to diagnose disease, direct treatment, and prognosticate. However, an ideal biomarker for brain injury has not been found.
In this review, we examine the various factors that must be taken into account in the search for a reliable biomarker in brain injury. We review the important studies that have investigated common biomarkers of structural brain injury, in particular S100B, neuron-specific enolase, myelin basic protein, and glial fibrillary acid protein.
The potential uses and limitations of these biomarkers in the context of TBI are discussed.
小儿创伤性脑损伤（TBI）的诊断、治疗及预后预测给临床治疗医生带来了重大挑战。尤其是用于评估损伤严重程度和预测预后的临床及放射学工具缺乏敏感性和特异性。在轻度TBI患者中，对于哪些患者应接受放射学成像检查以及哪些患者有长期神经后遗症风险往往存在不确定性。在重度TBI患者中，对于哪些患者会遭受继发性损伤以及个体患者的预后如何往往也存在不确定性。在其他几个临床专科中，生物标志物用于疾病诊断、指导治疗及预后预测。然而，尚未找到理想的脑损伤生物标志物。
在本综述中，我们研究了在寻找可靠的脑损伤生物标志物时必须考虑的各种因素。我们回顾了研究脑结构损伤常见生物标志物的重要研究，特别是S100B、神经元特异性烯醇化酶、髓鞘碱性蛋白和胶质纤维酸性蛋白。
讨论了这些生物标志物在TBI背景下的潜在用途和局限性。
