Mavroudis Ioannis, Kazis Dimitrios, Chowdhury Rumana, Petridis Foivos, Costa Vasiliki, Balmus Ioana-Miruna, Ciobica Alin, Luca Alina-Costina, Radu Iulian, Dobrin Romeo Petru, Baloyannis Stavros
Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK.
Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece.
Diagnostics (Basel). 2022 Mar 18;12(3):740. doi: 10.3390/diagnostics12030740.
Traumatic brain injury is a significant public health issue and represents the main contributor to death and disability globally among all trauma-related injuries. Martial arts practitioners, military veterans, athletes, victims of physical abuse, and epileptic patients could be affected by the consequences of repetitive mild head injuries (RMHI) that do not resume only to short-termed traumatic brain injuries (TBI) effects but also to more complex and time-extended outcomes, such as post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). These effects in later life are not yet well understood; however, recent studies suggested that even mild head injuries can lead to an elevated risk of later-life cognitive impairment and neurodegenerative disease. While most of the PCS hallmarks consist in immediate consequences and only in some conditions in long-termed processes undergoing neurodegeneration and impaired brain functions, the neuropathological hallmark of CTE is the deposition of p-tau immunoreactive pre-tangles and thread-like neurites at the depths of cerebral sulci and neurofibrillary tangles in the superficial layers I and II which are also one of the main hallmarks of neurodegeneration. Despite different CTE diagnostic criteria in clinical and research approaches, their specificity and sensitivity remain unclear and CTE could only be diagnosed post-mortem. In CTE, case risk factors include RMHI exposure due to profession (athletes, military personnel), history of trauma (abuse), or pathologies (epilepsy). Numerous studies aimed to identify imaging and fluid biomarkers that could assist diagnosis and probably lead to early intervention, despite their heterogeneous outcomes. Still, the true challenge remains the prediction of neurodegeneration risk following TBI, thus in PCS and CTE. Further studies in high-risk populations are required to establish specific, preferably non-invasive diagnostic biomarkers for CTE, considering the aim of preventive medicine.
创伤性脑损伤是一个重大的公共卫生问题，是全球所有创伤相关损伤中导致死亡和残疾的主要原因。武术从业者、退伍军人、运动员、身体虐待受害者和癫痫患者可能会受到重复性轻度头部损伤（RMHI）后果的影响，这些后果不仅限于短期创伤性脑损伤（TBI）的影响，还包括更复杂和长期的后果，如脑震荡后综合征（PCS）和慢性创伤性脑病（CTE）。这些晚年的影响尚未得到充分了解；然而，最近的研究表明，即使是轻度头部损伤也会导致晚年认知障碍和神经退行性疾病的风险升高。虽然大多数PCS的特征在于直接后果，仅在某些情况下存在于经历神经退行性变和脑功能受损的长期过程中，但CTE的神经病理学特征是在脑沟深处p-tau免疫反应性前缠结和丝状神经突的沉积，以及表层I和II中的神经原纤维缠结，这也是神经退行性变的主要特征之一。尽管临床和研究方法中CTE的诊断标准不同，但其特异性和敏感性仍不明确，CTE只能在死后诊断。在CTE中，病例风险因素包括因职业（运动员、军事人员）、创伤史（虐待）或病理（癫痫）导致的RMHI暴露。许多研究旨在识别可辅助诊断并可能导致早期干预的影像学和体液生物标志物，尽管结果各异。然而，真正的挑战仍然是预测TBI后，即PCS和CTE中的神经退行性变风险。考虑到预防医学的目标，需要对高危人群进行进一步研究，以建立针对CTE的特异性、最好是非侵入性的诊断生物标志物。
