Papa Linda, Ramia Michelle M, Edwards Damyan, Johnson Brian D, Slobounov Semyon M
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
J Neurotrauma. 2015 May 15;32(10):661-73. doi: 10.1089/neu.2014.3655. Epub 2015 Jan 23.
The aim of this study was to systematically review clinical studies examining biofluid biomarkers of brain injury for concussion in athletes. Data sources included PubMed, MEDLINE, and the Cochrane Database from 1966 to October 2013. Studies were included if they recruited athletes participating in organized sports who experienced concussion or head injury during a sports-related activity and had brain injury biomarkers measured. Acceptable research designs included experimental, observational, and case-control studies. Review articles, opinion papers, and editorials were excluded. After title and abstract screening of potential articles, full texts were independently reviewed to identify articles that met inclusion criteria. A composite evidentiary table was then constructed and documented the study title, design, population, methods, sample size, outcome measures, and results. The search identified 52 publications, of which 13 were selected and critically reviewed. All of the included studies were prospective and were published either in or after the year 2000. Sports included boxing (six studies), soccer (five studies), running/jogging (two studies), hockey (one study), basketball (one study), cycling (one study), and swimming (one study). The majority of studies (92%) had fewer than 100 patients. Three studies (23%) evaluated biomarkers in cerebrospinal fluid (CSF), one in both serum and CSF, and 10 (77%) in serum exclusively. There were 11 different biomarkers assessed, including S100β, glial fibrillary acidic protein, neuron-specific enolase, tau, neurofilament light protein, amyloid beta, brain-derived neurotrophic factor, creatine kinase and heart-type fatty acid binding protein, prolactin, cortisol, and albumin. A handful of biomarkers showed a correlation with number of hits to the head (soccer), acceleration/deceleration forces (jumps, collisions, and falls), postconcussive symptoms, trauma to the body versus the head, and dynamics of different sports. Although there are no validated biomarkers for concussion as yet, there is potential for biomarkers to provide diagnostic, prognostic, and monitoring information postinjury. They could also be combined with neuroimaging to assess injury evolution and recovery.
本研究的目的是系统回顾关于检测运动员脑震荡脑损伤生物流体生物标志物的临床研究。数据来源包括1966年至2013年10月的PubMed、MEDLINE和Cochrane数据库。纳入的研究需招募参加有组织运动的运动员，这些运动员在与运动相关的活动中经历了脑震荡或头部损伤，并检测了脑损伤生物标志物。可接受的研究设计包括实验性、观察性和病例对照研究。综述文章、观点论文和社论被排除。在对潜在文章进行标题和摘要筛选后，独立审查全文以确定符合纳入标准的文章。然后构建了一个综合证据表，记录了研究标题、设计、人群、方法、样本量、结局指标和结果。检索到52篇出版物，其中13篇被选中并进行了严格审查。所有纳入的研究都是前瞻性的，且均在2000年或之后发表。运动项目包括拳击（6项研究）、足球（5项研究）、跑步/慢跑（2项研究）、曲棍球（1项研究）、篮球（1项研究）、自行车运动（1项研究）和游泳（1项研究）。大多数研究（92%）的患者少于100例。3项研究（23%）评估了脑脊液（CSF）中的生物标志物，1项研究同时评估了血清和CSF中的生物标志物，10项研究（77%）仅评估了血清中的生物标志物。共评估了11种不同的生物标志物，包括S100β、胶质纤维酸性蛋白、神经元特异性烯醇化酶、tau蛋白、神经丝轻链蛋白、淀粉样β蛋白、脑源性神经营养因子、肌酸激酶和心型脂肪酸结合蛋白、催乳素、皮质醇和白蛋白。少数生物标志物显示与头部撞击次数（足球）、加速/减速力（跳跃、碰撞和跌倒）、脑震荡后症状、身体与头部的创伤以及不同运动的动力学相关。尽管目前尚无经过验证的脑震荡生物标志物，但生物标志物有可能提供损伤后的诊断、预后和监测信息。它们还可以与神经影像学相结合，以评估损伤的演变和恢复情况。
