Critical Care Medicine, Neurological Surgery and Pediatrics, Children's Hospital of Pittsburgh of UPMC, Safar Center for Resuscitation Research, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
PM R. 2011 Jun;3(6 Suppl 1):S31-8. doi: 10.1016/j.pmrj.2011.03.016.
Traumatic brain injury is a leading cause of morbidity and mortality in adults and children in the United States. Despite steady improvement in our understanding of the pathophysiology of acquired brain injuries, there has been remarkably little improvement in brain injury therapies and/or pharmacologic treatments over the past decade. One of the reasons may be the inability to properly stratify subjects for clinical trials and/or to have real-time assessment of the effectiveness of a given intervention. It has been recognized for several decades that serum biomarkers may allow for more objective subject stratification as well as act as surrogate markers of treatment efficacy. Despite numerous studies, however, biomarkers are not currently part of clinical practice in either acquired brain injury or other neurologic or musculoskeletal disorders. The goals of this review article, therefore, are to use traumatic brain injury as a example to discuss the use of biomarkers in clinical and randomized controlled trials; to briefly discuss the field of neuroproteomics and its interface with neurologic interventions; and to provide an overview of the collaborative pathway between academia and industry, which needs to be an integral part of the translation of biomarkers from the bench to the bedside in any clinical population. Introduction of the concept of rehabilomics and implications of biomarker use for the physical medicine and rehabilitation physician also are discussed.
创伤性脑损伤是美国成年人和儿童发病率和死亡率的主要原因。尽管我们对获得性脑损伤的病理生理学的理解稳步提高，但在过去十年中，脑损伤治疗和/或药物治疗的改善却非常有限。原因之一可能是无法正确对临床试验的受试者进行分层，以及无法实时评估给定干预措施的效果。几十年来，人们已经认识到血清生物标志物可以更客观地对受试者进行分层，并作为治疗效果的替代标志物。然而，尽管进行了大量研究，但生物标志物目前尚未纳入获得性脑损伤或其他神经或肌肉骨骼疾病的临床实践中。因此，本文的目的是使用创伤性脑损伤作为示例，讨论生物标志物在临床和随机对照试验中的应用；简要讨论神经保护组学领域及其与神经干预的接口；并概述学术界和工业界之间的合作途径，这是将生物标志物从实验室转化为任何临床人群的床边的重要组成部分。本文还介绍了康复组学的概念以及生物标志物的使用对物理医学与康复医师的影响。
