Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston, Houston, Texas, USA.
J Neurotrauma. 2013 Apr 15;30(8):657-70. doi: 10.1089/neu.2012.2439.
Mild traumatic brain injury (mTBI) results from a transfer of mechanical energy into the brain from traumatic events such as rapid acceleration/deceleration, a direct impact to the head, or an explosive blast. Transfer of energy into the brain can cause structural, physiological, and/or functional changes in the brain that may yield neurological, cognitive, and behavioral symptoms that can be long-lasting. Because mTBI can cause these symptoms in the absence of positive neuroimaging findings, its diagnosis can be subjective and often is based on self-reported neurological symptoms. Further, proper diagnosis can be influenced by the motivation to conceal or embellish signs and/or an inability of the patient to notice subtle dysfunctions or alterations of consciousness. Therefore, appropriate diagnosis of mTBI would benefit from objective indicators of injury. Concussion and mTBI are often used interchangeably, with concussion being primarily used in sport medicine, whereas mTBI is used in reference to traumatic injury. This review provides a critical assessment of the status of current biomarkers for the diagnosis of human mTBI. We review the status of biomarkers that have been tested in TBI patients with injuries classified as mild, and introduce a new concept for the discovery of biomarkers (termed symptophenotypes) to predict common and unique symptoms of concussion. Finally, we discuss the need for biomarker/biomarker signatures that can detect mTBI in the context of polytrauma, and to assess the consequences of repeated injury on the development of secondary injury syndrome, prolongation of post-concussion symptoms, and chronic traumatic encephalopathy.
轻度创伤性脑损伤（mTBI）是由于机械能量从创伤性事件转移到大脑中引起的，例如快速加速/减速、头部直接撞击或爆炸。能量转移到大脑中会导致大脑的结构、生理和/或功能发生变化，从而产生可能持久存在的神经、认知和行为症状。由于 mTBI 可以在没有阳性神经影像学发现的情况下引起这些症状，因此其诊断可能具有主观性，并且通常基于自我报告的神经症状。此外，适当的诊断可能会受到隐藏或夸大迹象的动机以及患者无法注意到细微的功能障碍或意识改变的能力的影响。因此，mTBI 的适当诊断将受益于损伤的客观指标。脑震荡和 mTBI 经常互换使用，脑震荡主要用于运动医学，而 mTBI 用于参考创伤性损伤。本综述对用于诊断人类 mTBI 的当前生物标志物的现状进行了批判性评估。我们回顾了在轻度损伤的 TBI 患者中进行测试的生物标志物的状态，并引入了一个用于发现生物标志物（称为症状表型）的新概念，以预测脑震荡的常见和独特症状。最后，我们讨论了需要能够在多发伤的情况下检测 mTBI 的生物标志物/生物标志物特征，以及评估重复损伤对继发性损伤综合征的发展、脑震荡后症状延长和慢性创伤性脑病的影响。
