Dagonnier Marie, Donnan Geoffrey A, Davis Stephen M, Dewey Helen M, Howells David W
Stroke Division, Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
Department of Neurology, Ambroise Paré Hospital, Mons, Belgium.
Front Neurol. 2021 Feb 5;12:619721. doi: 10.3389/fneur.2021.619721. eCollection 2021.
Distinguishing between stroke subtypes and knowing the time of stroke onset are critical in clinical practice. Thrombolysis and thrombectomy are very effective treatments in selected patients with acute ischemic stroke. Neuroimaging helps decide who should be treated and how they should be treated but is expensive, not always available and can have contraindications. These limitations contribute to the under use of these reperfusion therapies. An alternative approach in acute stroke diagnosis is to identify blood biomarkers which reflect the body's response to the damage caused by the different types of stroke. Specific blood biomarkers capable of differentiating ischemic from hemorrhagic stroke and mimics, identifying large vessel occlusion and capable of predicting stroke onset time would expedite diagnosis and increase eligibility for reperfusion therapies. To date, measurements of candidate biomarkers have usually occurred beyond the time window for thrombolysis. Nevertheless, some candidate markers of brain tissue damage, particularly the highly abundant glial structural proteins like GFAP and S100β and the matrix protein MMP-9 offer promising results. Grouping of biomarkers in panels can offer additional specificity and sensitivity for ischemic stroke diagnosis. Unbiased "omics" approaches have great potential for biomarker identification because of greater gene, protein, and metabolite coverage but seem unlikely to be the detection methodology of choice because of their inherent cost. To date, despite the evolution of the techniques used in their evaluation, no individual candidate or multimarker panel has proven to have adequate performance for use in an acute clinical setting where decisions about an individual patient are being made. Timing of biomarker measurement, particularly early when decision making is most important, requires urgent and systematic study.
在临床实践中，区分中风亚型并了解中风发作时间至关重要。溶栓和取栓术对部分急性缺血性中风患者是非常有效的治疗方法。神经影像学有助于确定哪些患者应接受治疗以及如何治疗，但费用高昂，并非随时可用，且可能存在禁忌证。这些局限性导致这些再灌注疗法的使用不足。急性中风诊断的另一种方法是识别血液生物标志物，这些标志物反映了身体对不同类型中风所造成损伤的反应。能够区分缺血性中风与出血性中风及类似病症、识别大血管闭塞并能够预测中风发作时间的特定血液生物标志物，将加快诊断并增加接受再灌注疗法的可能性。迄今为止，候选生物标志物的检测通常在溶栓时间窗之外进行。然而，一些脑组织损伤的候选标志物，特别是像胶质纤维酸性蛋白（GFAP）和S100β这样高度丰富的胶质结构蛋白以及基质金属蛋白酶-9（MMP-9），显示出了有前景的结果。将生物标志物组合成检测板可为缺血性中风诊断提供额外的特异性和敏感性。无偏倚的“组学”方法因能覆盖更多的基因、蛋白质和代谢物而在生物标志物识别方面具有巨大潜力，但因其固有成本似乎不太可能成为首选的检测方法。迄今为止，尽管用于评估的技术不断发展，但尚无单个候选标志物或多标志物检测板被证明在针对个体患者做出决策的急性临床环境中具有足够的性能。生物标志物检测的时机，尤其是在决策最为重要的早期，需要进行紧急且系统的研究。
