Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Stroke. 2013 Jan;15(1):27-37. doi: 10.5853/jos.2013.15.1.27. Epub 2013 Jan 31.
Major stroke clinical trials have failed during the past decades. The failures suggest the presence of heterogeneity among stroke patients. Biomarkers refer to indicators found in the blood, other body fluids or tissues that predicts physiologic or disease states, increased disease risk, or pharmacologic responses to a therapeutic intervention. Stroke biomarkers could be used as a guiding tool for more effective personalized therapy.
Three aspects of stroke biomarkers are explored in detail. First, the possible role of biomarkers in patients with stroke is discussed. Second, the limitations of conventional biomarkers (especially protein biomarkers) in the area of stroke research are presented with the reasons. Lastly, various types of biomarkers including traditional and novel genetic, microvesicle, and metabolomics-associated biomarkers are introduced with their advantages and disadvantages. We especially focus on the importance of comprehensive approaches using a variety of stroke biomarkers.
Although biomarkers are not recommended in practice guidelines for use in the diagnosis or treatment of stroke, many efforts have been made to overcome the limitations of biomarkers. The studies reviewed herein suggest that comprehensive analysis of different types of stroke biomarkers will improve the understanding of individual pathophysiologies and further promote the development of screening tools for of high-risk patients, and predicting models of stroke outcome and rational stroke therapy tailored to the characteristics of each case.
过去几十年间,大型中风临床试验都以失败告终。这些失败表明中风患者之间存在异质性。生物标志物是指在血液、其他体液或组织中发现的可预测生理或疾病状态、增加疾病风险或对治疗干预的药物反应的指标。中风生物标志物可用作更有效的个体化治疗的指导工具。
本文详细探讨了中风生物标志物的三个方面。首先,讨论了生物标志物在中风患者中的可能作用。其次,提出了传统生物标志物(尤其是蛋白质生物标志物)在中风研究领域的局限性及其原因。最后,介绍了各种类型的生物标志物,包括传统和新型遗传标志物、微泡和代谢组学相关生物标志物,以及它们的优缺点。我们特别关注使用多种中风生物标志物的综合方法的重要性。
尽管生物标志物在中风的诊断或治疗实践指南中不建议使用,但已经做出了许多努力来克服生物标志物的局限性。本文综述的研究表明,对不同类型的中风生物标志物进行综合分析将有助于加深对个体病理生理学的理解,并进一步促进高危患者的筛选工具的开发,以及针对每个病例的特点预测中风结局和合理的个体化治疗模型。