Ng Geelyn J L, Quek Amy M L, Cheung Christine, Arumugam Thiruma V, Seet Raymond C S
Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.
Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Neurochem Int. 2017 Jul;107:11-22. doi: 10.1016/j.neuint.2017.01.005. Epub 2017 Jan 11.
Biomarkers provide critical mechanistic insights to key biologic processes that occur during cerebral ischemia which, when carefully applied, can improve clinical decision-making in acute stroke management. The translation of a blood-based biomarker in ischemic stroke to clinical practice is challenging, in part, due to the complexity of ischemic stroke pathogenesis and the presence of a blood-brain barrier that restricts the release of brain-specific markers into the circulation. The pathologic and clinical aspects of ischemic stroke are described in this review, where a non-exhaustive list of biomarkers that interrogate different aspects of ischemic stroke such as oxidative damage, inflammation, thrombus formation, cardiac function and brain injury are described. The potential roles of these biomarkers are further examined under different clinical scenarios aimed at (1) averting the risk of hemorrhagic transformation, (2) identifying individuals at risk of early neurologic deterioration and malignant infarction, (3) aiding in the diagnosis of ischemic stroke and its differentiation from other stroke mimics, (4) guiding the search for stroke etiology, and (5) assessing stroke risk within the community. Researchers should explore the roles of stroke biomarkers to enhance clinical decision-making that is presently largely based on intuition and subjective reasoning.
生物标志物为脑缺血期间发生的关键生物学过程提供了重要的机制性见解，若能谨慎应用，可改善急性卒中管理中的临床决策。将基于血液的生物标志物应用于缺血性卒中的临床实践具有挑战性，部分原因在于缺血性卒中发病机制的复杂性以及血脑屏障的存在，血脑屏障会限制脑特异性标志物释放到循环系统中。本综述描述了缺血性卒中的病理和临床方面，其中还介绍了一系列生物标志物，这些生物标志物涉及缺血性卒中的不同方面，如氧化损伤、炎症、血栓形成、心脏功能和脑损伤等，但并未详尽罗列。在不同临床场景下，进一步探讨了这些生物标志物的潜在作用，这些场景旨在：（1）避免出血转化风险；（2）识别有早期神经功能恶化和恶性梗死风险的个体；（3）辅助缺血性卒中的诊断及其与其他疑似卒中疾病的鉴别；（4）指导寻找卒中病因；（5）评估社区内的卒中风险。研究人员应探索卒中生物标志物的作用，以加强目前很大程度上基于直觉和主观推理的临床决策。
