Sapin V, Gaulmin R, Aubin R, Walrand S, Coste A, Abbot M
Biochemistry and molecular biology department, CHU Gabriel-Montpied, Clermont-Ferrand, France.
ASM Clermont Auvergne, service médical, 63028 Clermont-Ferrand cedex 2, France.
Neurochirurgie. 2021 May;67(3):249-254. doi: 10.1016/j.neuchi.2021.01.001. Epub 2021 Jan 19.
Mild traumatic brain injury (mTBI) is one of the most common causes of emergency department visits around the world. Up to 90% of injuries are classified as mTBI. Cranial computed tomography (CCT) is a standard diagnosis tool to identify intracranial complications in adults with mTBI. Alternatively, children can be admitted for inpatient observation with CCT scans performed only on those with clinical deterioration. The use of blood biomarkers is a supplementary tool for identifying patients at risk of intracerebral lesions who may need imaging.
We realised a bibliographic state of art providing a contemporary clinical and laboratory framework for blood biomarker testing in mTBI management.
The S100B protein is the only biomarker that can be used today in the clinical routine for management of mTBI with appropriate evidence-based medicine. Due to its excellent negative predictive value, S100B protein is an alternative choice to CCT scanning for mTBI management with considered, consensual and pragmatic use. In this state of art, we propose points to help clinicians and clinical pathologists use serum S100B protein in the clinical routine. A state of art on the different biomarkers (GFAP, UCH-L1, NF [H or L], tau, H-FABP, SNTF, NSE, miRNAs, MBP) is also conducted. Some of these other biomarkers, used alone (GFAP, UCH-L1) or in combination (GFAP+H-FABP±S100B±IL10) can improve the specificity of S100B.
Using a bibliographic state of art, we highlighted the added values of the blood biomarkers for the clinical management of mTBI.
轻度创伤性脑损伤（mTBI）是全球急诊就诊的最常见原因之一。高达90%的损伤被归类为mTBI。头颅计算机断层扫描（CCT）是识别成年mTBI患者颅内并发症的标准诊断工具。另外，儿童可入院进行住院观察，仅对临床病情恶化的患儿进行CCT扫描。血液生物标志物的使用是识别可能需要影像学检查的脑内病变风险患者的辅助工具。
我们实现了一份文献综述，为mTBI管理中的血液生物标志物检测提供当代临床和实验室框架。
S100B蛋白是目前唯一可在临床常规中用于mTBI管理且有适当循证医学依据的生物标志物。由于其出色的阴性预测价值，S100B蛋白是CCT扫描的替代选择，可在经过深思熟虑、达成共识且务实的情况下用于mTBI管理。在本综述中，我们提出了一些要点，以帮助临床医生和临床病理学家在临床常规中使用血清S100B蛋白。还对不同生物标志物（胶质纤维酸性蛋白[GFAP]、泛素羧基末端水解酶L1[UCH-L1]、神经丝蛋白[NF][重链或轻链]、tau蛋白、心脏型脂肪酸结合蛋白[H-FABP]、溶质载体家族1成员2[SNTF]、神经元特异性烯醇化酶[NSE]、微小RNA[miRNAs]、髓鞘碱性蛋白[MBP]）进行了综述。这些其他生物标志物中的一些单独使用（GFAP、UCH-L1）或联合使用（GFAP+H-FABP±S100B±白细胞介素10[IL10]）可提高S100B的特异性。
通过文献综述，我们强调了血液生物标志物在mTBI临床管理中的附加价值。
