Burrell Christian, Avalon Nicole E, Siegel Jason, Pizzi Michael, Dutta Tumpa, Charlesworth M Cristine, Freeman William D
a Department of Neurology , Mayo Clinic , Jacksonville , FL , USA.
b Endocrine Research Unit , Mayo Clinic , Rochester , MN , USA.
Expert Rev Neurother. 2016 Nov;16(11):1251-1262. doi: 10.1080/14737175.2016.1203257. Epub 2016 Jul 11.
Precision medicine provides individualized treatment of diseases through leveraging patient-to-patient variation. Aneurysmal subarachnoid hemorrhage carries tremendous morbidity and mortality with cerebral vasospasm and delayed cerebral ischemia proving devastating and unpredictable. Lack of treatment measures for these conditions could be improved through precision medicine. Areas covered: Discussed are the pathophysiology of CV and DCI, treatment guidelines, and evidence for precision medicine used for prediction and prevention of poor outcomes following aSAH. A PubMed search was performed using keywords cerebral vasospasm or delayed cerebral ischemia and either biomarkers, precision medicine, metabolomics, proteomics, or genomics. Over 200 peer-reviewed articles were evaluated. The studies presented cover biomarkers identified as predictive markers or therapeutic targets following aSAH. Expert commentary: The biomarkers reviewed here correlate with CV, DCI, and neurologic outcomes after aSAH. Though practical use in clinical management of aSAH is not well established, using these biomarkers as predictive tools or therapeutic targets demonstrates the potential of precision medicine.
精准医学通过利用患者之间的差异实现疾病的个体化治疗。动脉瘤性蛛网膜下腔出血具有极高的发病率和死亡率，脑血管痉挛和迟发性脑缺血具有极大的破坏性且不可预测。精准医学有望改善针对这些病症的治疗措施。涵盖领域：本文讨论了脑血管痉挛和迟发性脑缺血的病理生理学、治疗指南以及用于预测和预防动脉瘤性蛛网膜下腔出血后不良结局的精准医学证据。使用关键词“脑血管痉挛”或“迟发性脑缺血”以及生物标志物、精准医学、代谢组学、蛋白质组学或基因组学在PubMed上进行了检索。评估了200多篇同行评审文章。所呈现的研究涵盖了被确定为动脉瘤性蛛网膜下腔出血后预测标志物或治疗靶点的生物标志物。专家评论：本文所综述的生物标志物与动脉瘤性蛛网膜下腔出血后的脑血管痉挛、迟发性脑缺血和神经学结局相关。尽管在动脉瘤性蛛网膜下腔出血的临床管理中的实际应用尚未得到充分确立，但将这些生物标志物用作预测工具或治疗靶点显示了精准医学的潜力。
