Romeu-Mejia Rafael, Giza Christopher C, Goldman Joshua T
Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA.
UCLA Brain Injury Research Center, Los Angeles, CA, USA.
Curr Rev Musculoskelet Med. 2019 Jun;12(2):105-116. doi: 10.1007/s12178-019-09536-8.
The concussion public health burden has increased alongside our knowledge of the pathophysiology of mild traumatic brain injury (mTBI). The purpose of this review is to summarize our current understanding of mTBI pathophysiology and biomechanics and how these underlying principles correlate with clinical manifestations of mTBI.
Changes in post-mTBI glutamate and GABA concentrations seem to be region-specific and time-dependent. Genetic variability may predict recovery and symptom severity while gender differences appear to be associated with the neuroinflammatory response and neuroplasticity. Ongoing biomechanical research has shown a growing body of evidence in support of an "individual-specific threshold" for mTBI that varies based on individual intrinsic factors. The literature demonstrates a well-characterized timeframe for mTBI pathophysiologic changes in animal models while work in this area continues to grow in humans. Current human research shows that these underlying post-mTBI effects are multifactorial and may correlate with symptomatology and recovery. While wearable sensor technology has advanced biomechanical impact research, a definitive concussion threshold remains elusive.
随着我们对轻度创伤性脑损伤（mTBI）病理生理学的了解，脑震荡的公共卫生负担有所增加。本综述的目的是总结我们目前对mTBI病理生理学和生物力学的理解，以及这些基本原理如何与mTBI的临床表现相关联。
mTBI后谷氨酸和γ-氨基丁酸浓度的变化似乎具有区域特异性且随时间变化。基因变异性可能预测恢复情况和症状严重程度，而性别差异似乎与神经炎症反应和神经可塑性有关。正在进行的生物力学研究表明，越来越多的证据支持mTBI存在“个体特异性阈值”，该阈值因个体内在因素而异。文献显示了动物模型中mTBI病理生理变化的特征明确的时间框架，而该领域在人类中的研究仍在不断发展。目前的人体研究表明，这些mTBI后的潜在影响是多因素的，可能与症状和恢复相关。虽然可穿戴传感器技术推动了生物力学撞击研究，但确定的脑震荡阈值仍然难以捉摸。
