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脑损伤的神经生物标志物能否用于预测中风后运动恢复?一项系统综述。

Can Neurological Biomarkers of Brain Impairment Be Used to Predict Poststroke Motor Recovery? A Systematic Review.

作者信息

Kim Bokkyu, Winstein Carolee

机构信息

University of Southern California, Los Angeles, CA, USA.

University of Southern California, Los Angeles, CA, USA

出版信息

Neurorehabil Neural Repair. 2017 Jan;31(1):3-24. doi: 10.1177/1545968316662708. Epub 2016 Aug 8.

Abstract

Background There is growing interest to establish recovery biomarkers, especially neurological biomarkers, in order to develop new therapies and prediction models for the promotion of stroke rehabilitation and recovery. However, there is no consensus among the neurorehabilitation community about which biomarker(s) have the highest predictive value for motor recovery. Objective To review the evidence and determine which neurological biomarker(s) meet the high evidence quality criteria for use in predicting motor recovery. Methods We searched databases for prognostic neuroimaging/neurophysiological studies. Methodological quality of each study was assessed using a previously employed comprehensive 15-item rating system. Furthermore, we used the GRADE approach and ranked the overall evidence quality for each category of neurologic biomarker. Results Seventy-one articles met our inclusion criteria; 5 categories of neurologic biomarkers were identified: diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), functional magnetic resonance imaging (fMRI), conventional structural MRI (sMRI), and a combination of these biomarkers. Most studies were conducted with individuals after ischemic stroke in the acute and/or subacute stage (~70%). Less than one-third of the studies (21/71) were assessed with satisfactory methodological quality (80% or more of total quality score). Conventional structural MRI and the combination biomarker categories ranked "high" in overall evidence quality. Conclusions There were 3 prevalent methodological limitations: (a) lack of cross-validation, (b) lack of minimal clinically important difference (MCID) for motor outcomes, and (c) small sample size. More high-quality studies are needed to establish which neurological biomarkers are the best predictors of motor recovery after stroke. Finally, the quarter-century old methodological quality tool used here should be updated by inclusion of more contemporary methods and statistical approaches.

摘要

背景 为了开发促进中风康复和恢复的新疗法及预测模型,人们对建立恢复生物标志物,尤其是神经生物标志物的兴趣日益浓厚。然而,神经康复学界对于哪种生物标志物对运动恢复具有最高预测价值尚未达成共识。目的 回顾相关证据,确定哪些神经生物标志物符合用于预测运动恢复的高证据质量标准。方法 我们在数据库中搜索了预后神经影像学/神经生理学研究。使用先前采用的包含15个条目的综合评分系统评估每项研究的方法学质量。此外,我们采用GRADE方法对每类神经生物标志物的总体证据质量进行排名。结果 71篇文章符合我们的纳入标准;确定了5类神经生物标志物:扩散张量成像(DTI)、经颅磁刺激(TMS)、功能磁共振成像(fMRI)、传统结构磁共振成像(sMRI)以及这些生物标志物的组合。大多数研究是在缺血性中风急性期和/或亚急性期的个体中进行的(约70%)。不到三分之一的研究(21/71)在方法学质量评估中获得满意结果(总质量得分的80%或更高)。传统结构磁共振成像和组合生物标志物类别在总体证据质量方面排名“高”。结论 存在3个普遍的方法学局限性:(a)缺乏交叉验证,(b)缺乏运动结果的最小临床重要差异(MCID),(c)样本量小。需要更多高质量研究来确定哪些神经生物标志物是中风后运动恢复的最佳预测指标。最后,这里使用的已有25年历史的方法学质量工具应通过纳入更现代的方法和统计方法进行更新。

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