Manivannan Susruta, Makwana Milan, Ahmed Aminul Islam, Zaben Malik
Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom.
Clinical Neurosciences, University of Southampton, Southampton, SO16 6YD, United Kingdom; Wessex Neurological Centre, University Hospitals Southampton, Southampton, SO16 6YD, United Kingdom.
Clin Neurol Neurosurg. 2018 Aug;171:6-20. doi: 10.1016/j.clineuro.2018.05.017. Epub 2018 May 18.
Traumatic brain injury (TBI) poses a major public health problem on a global scale. Its burden results from high mortality and significant morbidity in survivors. This stems, in part, from an ongoing inadequacy in diagnostic and prognostic indicators despite significant technological advances. Traumatic axonal injury (TAI) is a key driver of the ongoing pathological process following TBI, causing chronic neurological deficits and disability. The science underpinning biomarkers of TAI has been a subject of many reviews in recent literature. However, in this review we provide a comprehensive account of biomarkers from animal models to clinical studies, bridging the gap between experimental science and clinical medicine. We have discussed pathogenesis, temporal kinetics, relationships to neuro-imaging, and, most importantly, clinical applicability in order to provide a holistic perspective of how this could improve TBI diagnosis and predict clinical outcome in a real-life setting. We conclude that early and reliable identification of axonal injury post-TBI with the help of body fluid biomarkers could enhance current care of TBI patients by (i) increasing speed and accuracy of diagnosis, (ii) providing invaluable prognostic information, (iii) allow efficient allocation of rehabilitation services, and (iv) provide potential therapeutic targets. The optimal model for assessing TAI is likely to involve multiple components, including several blood biomarkers and neuro-imaging modalities, at different time points.
创伤性脑损伤（TBI）在全球范围内构成了一个重大的公共卫生问题。其负担源于高死亡率以及幸存者的显著发病率。尽管技术取得了重大进步，但这部分是由于诊断和预后指标仍存在不足。创伤性轴索损伤（TAI）是TBI后持续病理过程的关键驱动因素，会导致慢性神经功能缺损和残疾。TAI生物标志物的相关科学一直是近期文献中诸多综述的主题。然而，在本综述中，我们全面阐述了从动物模型到临床研究的生物标志物，弥合了实验科学与临床医学之间的差距。我们讨论了发病机制、时间动力学、与神经影像学的关系，以及最重要的临床适用性，以便从整体角度说明这如何能够改善TBI的诊断并在实际临床环境中预测临床结果。我们得出结论，借助体液生物标志物对TBI后轴索损伤进行早期且可靠的识别，可通过以下方式改善当前对TBI患者的护理：（i）提高诊断速度和准确性，（ii）提供宝贵的预后信息，（iii）实现康复服务的有效分配，以及（iv）提供潜在的治疗靶点。评估TAI的最佳模型可能需要在不同时间点纳入多个组成部分，包括多种血液生物标志物和神经影像学检查方法。
