Department of Critical Care Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Neurocrit Care. 2019 Feb;30(1):22-32. doi: 10.1007/s12028-018-0522-z.
This scoping review will discuss the basic functions and prognostic significance of the commonly researched cytokines implicated in severe traumatic brain injury (sTBI), including tumour necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), transforming growth factor-β (TGF-β), substance P, and soluble CD40 ligand (sCD40L). A scoping review was undertaken with an electronic search for articles from the Ovid MEDLINE, PUBMED and EMBASE databases from 1995 to 2017. Inclusion criteria were original research articles, and reviews including both animal models and human clinical studies of acute (< 3 months) sTBI. Selected articles included both isolated sTBI and sTBI with systemic injury. After applying the inclusion criteria and removing duplicates, 141 full-text articles, 126 original research articles and 15 review articles, were evaluated in compiling this review paper. A single reviewer, CC, completed the review in two phases. During the first phase, titles and abstracts of selected articles were reviewed for inclusion. A second evaluation was then conducted on the full text of all selected articles to ensure relevancy. From our current understanding of the literature, it is unlikely a single biomarker will be sufficient in accurately prognosticating patients with sTBI. Intuitively, a more severe injury will demonstrate higher levels of inflammatory cytokines which may correlate as a marker of severe injury. This does not mean, necessarily, these cytokines have a direct and causal role in the poor outcome of the patient. Further research is required to better delineate the complex systemic inflammatory and CNS interactions that occur during sTBI before they can be applied as a reliable prognostic tool.
这篇范围界定综述将讨论在严重创伤性脑损伤（sTBI）中研究较多的细胞因子的基本功能和预后意义，包括肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、IL-6、基质金属蛋白酶组织抑制剂-1（TIMP-1）、转化生长因子-β（TGF-β）、P 物质和可溶性 CD40 配体（sCD40L）。通过电子检索 Ovid MEDLINE、PUBMED 和 EMBASE 数据库，从 1995 年到 2017 年进行了范围界定综述。纳入标准为原始研究文章和综述，包括急性（<3 个月）sTBI 的动物模型和人类临床研究。入选文章包括单纯 sTBI 和合并全身损伤的 sTBI。在应用纳入标准和去除重复后，评估了 141 篇全文文章、126 篇原始研究文章和 15 篇综述文章，以编写本综述。CC 作为单一审查员分两个阶段完成了审查。在第一阶段，对入选文章的标题和摘要进行了评估。然后对所有入选文章的全文进行了第二次评估，以确保相关性。根据我们目前对文献的理解，不太可能有一种单一的生物标志物足以准确预测 sTBI 患者的预后。直观地说，更严重的损伤会表现出更高水平的炎症细胞因子，这可能是严重损伤的标志物。这并不意味着这些细胞因子必然在患者的不良预后中具有直接的因果关系。需要进一步研究，以更好地描绘 sTBI 期间发生的复杂全身炎症和中枢神经系统相互作用，然后才能将其作为可靠的预后工具。
