Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Sina Hospital, Hassan-Abad Square, Imam Khomeini Ave, Tehran, 11365-3876, Iran.
Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Neurocrit Care. 2021 Oct;35(2):559-572. doi: 10.1007/s12028-020-01173-1. Epub 2021 Jan 5.
Emerging evidence suggests that biofluid-based biomarkers have diagnostic and prognostic potential in traumatic brain injuries (TBI). However, owing to the lack of a conceptual framework or comprehensive review, it is difficult to visualize the breadth of materials that might be available. We conducted a systematic scoping review to map and categorize the evidence regarding biofluid-based biochemical markers of TBI. A comprehensive search was undertaken in January 2019. Of 25,354 records identified through the literature search, 1036 original human studies were included. Five hundred forty biofluid biomarkers were extracted from included studies and classified into 19 distinct categories. Three categories of biomarkers including cytokines, coagulation tests, and nerve tissue proteins were investigated more than others and assessed in almost half of the studies (560, 515, and 502 from 1036 studies, respectively). S100 beta as the most common biomarker for TBI was tested in 21.2% of studies (220 articles). Cortisol was the only biomarker measured in blood, cerebrospinal fluid, urine, and saliva. The most common sampling time was at admission and within 24 h of injury. The included studies focused mainly on biomarkers from blood and central nervous system sources, the adult population, and severe and blunt injuries. The most common outcome measures used in studies were changes in biomarker concentration level, Glasgow coma scale, Glasgow outcome scale, brain computed tomography scan, and mortality rate. Biofluid biomarkers could be clinically helpful in the diagnosis and prognosis of TBI. However, there was no single definitive biomarker with accurate characteristics. The present categorization would be a road map to investigate the biomarkers of the brain injury cascade separately and detect the most representative biomarker of each category. Also, this comprehensive categorization could provide a guiding framework to design combined panels of multiple biomarkers.
越来越多的证据表明，生物体液中的生物标志物在创伤性脑损伤 (TBI) 中有诊断和预后的潜力。然而，由于缺乏概念框架或全面的综述，很难想象可能获得的材料的广度。我们进行了系统的范围综述，以绘制和分类有关 TBI 的生物体液生物化学标志物的证据。2019 年 1 月进行了全面搜索。通过文献搜索确定了 25,354 条记录，其中包括 1036 项原始人类研究。从纳入的研究中提取了 540 种生物流体生物标志物，并将其分为 19 个不同类别。包括细胞因子、凝血试验和神经组织蛋白在内的三类生物标志物比其他标志物研究得更多，在近一半的研究中进行了评估（分别来自 1036 项研究中的 560、515 和 502 项）。S100β作为最常见的 TBI 生物标志物，在 21.2%的研究中进行了测试（220 篇文章）。皮质醇是唯一在血液、脑脊液、尿液和唾液中测量的生物标志物。最常见的采样时间是入院时和受伤后 24 小时内。纳入的研究主要集中在血液和中枢神经系统来源、成人和严重钝性损伤的生物标志物上。研究中最常用的结果测量指标是生物标志物浓度水平、格拉斯哥昏迷量表、格拉斯哥结局量表、脑计算机断层扫描和死亡率的变化。生物流体生物标志物在 TBI 的诊断和预后中可能具有临床意义。然而，没有一种具有准确特征的单一明确的生物标志物。目前的分类将是一个路线图，可以分别研究脑损伤级联的生物标志物，并检测每个类别的最具代表性的生物标志物。此外，这种全面的分类可以为设计多个生物标志物的组合面板提供一个指导框架。
