Oliveira Carla Oliveira de, Ikuta Nilo, Regner Andrea
Programa de Pós-Graduação em Diagnóstico Genético e Molecular, Universidade Luterana do Brasil, Canoas, RS, Brasil.
Programa de Pós-Graduação em Diagnóstico Genético e Molecular, Universidade Luterana do Brasil.
Rev Bras Ter Intensiva. 2008 Dec;20(4):411-21.
Trauma is the leading cause of death of people from 1 to 44 years of age. Traumatic brain injury is the main determinant for mortality and morbidity caused by trauma. Outcome prediction is one of the major problems related to severe traumatic brain injury because clinical evaluation has an unreliable predictive value and complicates identification of patients with higher risk of developing secondary lesions and fatal outcome. That is why, there is considerable interest in development of biomarkers that reflect the severity of brain injury and correlate with mortality and functional outcome. Proteins S100B and neuron specific enolases are among the markers most studied for this purpose, however some studies are investigating glial fibrillary acidic protein, creatinine phospokinase, isoenzime B, myelin basic protein, plasma desoxiribonucleic acid, heat shock protein 70, von Willebrand factor, metalloproteinases and brain-derived neurotrophic factor, among others. Evidence suggests that inflammation, oxidative stress, excitotoxicity, neuroendocrine responses and apoptosis play an important role in the development of secondary lesions. Markers involved in these processes are being studied in traumatic brain injury. We reviewed these biomarkers, some of which present promising results for future clinical application.
创伤是1至44岁人群的主要死因。创伤性脑损伤是创伤导致死亡和发病的主要决定因素。结果预测是与严重创伤性脑损伤相关的主要问题之一，因为临床评估的预测价值不可靠，并且难以识别发生继发性损伤和致命后果风险较高的患者。正因为如此，人们对开发能够反映脑损伤严重程度并与死亡率和功能结果相关的生物标志物有着浓厚的兴趣。蛋白质S100B和神经元特异性烯醇化酶是为此目的研究最多的标志物之一，然而，一些研究正在调查胶质纤维酸性蛋白、肌酸磷酸激酶、同工酶B、髓鞘碱性蛋白、血浆脱氧核糖核酸、热休克蛋白70、血管性血友病因子、金属蛋白酶和脑源性神经营养因子等。有证据表明，炎症、氧化应激、兴奋性毒性、神经内分泌反应和细胞凋亡在继发性损伤的发生中起重要作用。参与这些过程的标志物正在创伤性脑损伤中进行研究。我们综述了这些生物标志物，其中一些在未来临床应用中呈现出有前景的结果。
