Bogoslovsky Tanya, Gill Jessica, Jeromin Andreas, Davis Cora, Diaz-Arrastia Ramon
Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Rockville, MD 20856, USA.
National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20814, USA.
Diagnostics (Basel). 2016 Oct 18;6(4):37. doi: 10.3390/diagnostics6040037.
Traumatic brain injury (TBI) is one of the leading causes of death and disability around the world. The lack of validated biomarkers for TBI is a major impediment to developing effective therapies and improving clinical practice, as well as stimulating much work in this area. In this review, we focus on different settings of TBI management where blood or cerebrospinal fluid (CSF) biomarkers could be utilized for predicting clinically-relevant consequences and guiding management decisions. Requirements that the biomarker must fulfill differ based on the intended context of use (CoU). Specifically, we focus on fluid biomarkers in order to: (1) identify patients who may require acute neuroimaging (cranial computerized tomography (CT) or magnetic resonance imaging (MRI); (2) select patients at risk for secondary brain injury processes; (3) aid in counseling patients about their symptoms at discharge; (4) identify patients at risk for developing postconcussive syndrome (PCS), posttraumatic epilepsy (PTE) or chronic traumatic encephalopathy (CTE); (5) predict outcomes with respect to poor or good recovery; (6) inform counseling as to return to work (RTW) or to play. Despite significant advances already made from biomarker-based studies of TBI, there is an immediate need for further large-scale studies focused on identifying and innovating sensitive and reliable TBI biomarkers. These studies should be designed with the intended CoU in mind.
创伤性脑损伤（TBI）是全球死亡和残疾的主要原因之一。缺乏经过验证的TBI生物标志物是开发有效治疗方法、改善临床实践以及推动该领域大量研究工作的主要障碍。在本综述中，我们重点关注TBI管理的不同场景，其中血液或脑脊液（CSF）生物标志物可用于预测临床相关后果并指导管理决策。生物标志物必须满足的要求因预期使用背景（CoU）而异。具体而言，我们关注液体生物标志物的目的是：（1）识别可能需要进行急性神经影像学检查（头颅计算机断层扫描（CT）或磁共振成像（MRI））的患者；（2）选择有继发性脑损伤过程风险的患者；（3）帮助指导患者出院时关于其症状的咨询；（4）识别有发生脑震荡后综合征（PCS）、创伤后癫痫（PTE）或慢性创伤性脑病（CTE）风险的患者；（5）预测恢复情况好坏的结果；（6）为关于重返工作（RTW）或重返运动的咨询提供信息。尽管基于生物标志物的TBI研究已经取得了重大进展，但迫切需要进一步开展大规模研究，专注于识别和创新敏感且可靠的TBI生物标志物。这些研究应在设计时考虑预期的CoU。
