Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands,
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.
Cerebrovasc Dis. 2019;47(5-6):207-216. doi: 10.1159/000502449. Epub 2019 Aug 30.
A rapid serum biomarker that confirms or rules out a transient ischemic attack (TIA) would be of great value in clinical practice. We aimed to systematically review current evidence for the diagnostic accuracy of blood biomarkers in the early diagnosis of TIA.
This is a systematic review with quality appraisal of individual studies using the QUADAS-2 tool. MEDLINE and EMBASE databases were searched up to May 1, 2017, to select primary diagnostic accuracy studies evaluating potential biomarkers in blood for the diagnosis of TIA or ischemic stroke.
Of 4,215 studies retrieved, 78 met our eligibility criteria. Forty-five studies restricted their population to ischemic stroke patients, 32 included both TIA and ischemic stroke patients, and only one study was restricted to TIA patients. In total 62/78 (79.5%) studies had a case-control design comparing TIA or stroke patients with healthy subjects. Overall, 125 single biomarkers and 5 biomarker panels were studied, with a median number of participants per study of 92.0 (interquartile range 44.8-144.5), varying from 8 to 915. Sufficient information to extract 2 × 2 tables was available for 35 (44.9%) articles, and for 60 (48.0 %) biomarkers. Several markers, such as NR2A/B (antibodies), Parkinson 7, nucleoside diphosphate kinase A, ubiquitin fusion degradation protein-1, and heart-type fatty acid binding protein, have shown moderate to high diagnostic accuracy in multiple studies.
Although the methodological quality of studies evaluating biomarkers of brain ischemia was poor, several biomarkers have shown the potential to detect transient brain ischemia in an early phase. Diagnostic accuracy studies in suspected cases of TIA are needed to determine their true clinical value.
一种能够快速确定或排除短暂性脑缺血发作（TIA）的血清生物标志物将具有重要的临床价值。本研究旨在系统评价当前用于 TIA 早期诊断的血液生物标志物的诊断准确性的证据。
本研究为系统评价，采用 QUADAS-2 工具对单个研究进行质量评估。检索 MEDLINE 和 EMBASE 数据库，以选择评估血液中潜在生物标志物用于 TIA 或缺血性脑卒中诊断的初步诊断准确性研究。
共检索到 4215 篇文献，其中 78 篇符合纳入标准。45 项研究将研究人群限定为缺血性脑卒中患者，32 项研究同时纳入 TIA 和缺血性脑卒中患者，仅有 1 项研究仅纳入 TIA 患者。共 62/78（79.5%）项研究采用病例对照设计，将 TIA 或脑卒中患者与健康对照者进行比较。总体上，共研究了 125 个单一生物标志物和 5 个生物标志物组合，每个研究的中位纳入人数为 92.0（四分位间距 44.8~144.5），纳入人数从 8 至 915 不等。有 35 篇（44.9%）文章和 60 个（48.0%）生物标志物有足够的信息提取 2×2 表。在多项研究中，一些标志物如 NR2A/B（抗体）、Parkinson7、核苷酸二磷酸激酶 A、泛素融合降解蛋白 1 和心脏型脂肪酸结合蛋白显示出了中等至高度的诊断准确性。
尽管评估脑缺血生物标志物的研究方法学质量较差，但一些生物标志物已显示出在早期检测短暂性脑缺血的潜力。需要对疑似 TIA 患者进行诊断准确性研究，以确定其真正的临床价值。
