Li Weili, Pan Rong, Qi Zhifeng, Liu Ke Jian
Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China.
Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Brain Circ. 2018 Oct-Dec;4(4):145-152. doi: 10.4103/bc.bc_11_18. Epub 2018 Dec 31.
Ischemic stroke is a leading cause of death and disability. Fear of intracranial hemorrhage (ICH) has been the primary reason for withholding tissue plasminogen activator (tPA) and thrombectomy, the only two widely accepted treatments for ischemic stroke. Thrombolysis treatment is only allowed in a very narrow time window (within 4.5-6 h). However, so far, other than the time window guideline, there is no reliable indicator available in the clinic to predict ICH before thrombolysis treatment. Recently, extensive research efforts have been devoted to the development of reliable indicators to predict ICH and safely guide the thrombolysis treatment. Accumulating evidence suggests that ischemic brain regions with a compromised blood-brain barrier (BBB) before tPA treatment develop ICH at the later time during thrombolytic reperfusion. Assessing BBB damage before thrombolysis could potentially help predict the risk of ICH after thrombolysis. This article reviews the literature reports on BBB damage biomarkers that have been developed in recent years, including biochemical markers such as BBB structural proteins, circulating brain microvascular endothelial cells, plasma albumin, and brain parenchyma proteins, as well as image markers such as magnetic resonance imaging assessment for BBB damage.
缺血性中风是导致死亡和残疾的主要原因。对颅内出血（ICH）的担忧一直是不使用组织型纤溶酶原激活剂（tPA）和血栓切除术的主要原因，这两种是缺血性中风仅有的两种被广泛接受的治疗方法。溶栓治疗仅在非常狭窄的时间窗内（4.5 - 6小时内）允许使用。然而，到目前为止，除了时间窗指南外，临床上尚无可靠指标可在溶栓治疗前预测颅内出血。最近，大量研究致力于开发可靠指标以预测颅内出血并安全指导溶栓治疗。越来越多的证据表明，在tPA治疗前血脑屏障（BBB）受损的缺血性脑区在溶栓再灌注后期会发生颅内出血。在溶栓前评估血脑屏障损伤可能有助于预测溶栓后颅内出血的风险。本文综述了近年来关于血脑屏障损伤生物标志物的文献报道，包括血脑屏障结构蛋白、循环脑微血管内皮细胞、血浆白蛋白和脑实质蛋白等生化标志物，以及用于血脑屏障损伤评估的磁共振成像等影像标志物。
