中风后预后功能恢复的生物标志物:一项叙述性综述。

Biomarkers for prognostic functional recovery poststroke: A narrative review.

作者信息

Zhang Jack Jiaqi, Sánchez Vidaña Dalinda Isabel, Chan Jackie Ngai-Man, Hui Edward S K, Lau Kui Kai, Wang Xin, Lau Benson W M, Fong Kenneth N K

机构信息

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.

Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.

出版信息

Front Cell Dev Biol. 2023 Jan 9;10:1062807. doi: 10.3389/fcell.2022.1062807. eCollection 2022.

Abstract

Prediction of poststroke recovery can be expressed by prognostic biomarkers that are related to the pathophysiology of stroke at the cellular and molecular level as well as to the brain structural and functional reserve after stroke at the systems neuroscience level. This study aimed to review potential biomarkers that can predict poststroke functional recovery. A narrative review was conducted to qualitatively summarize the current evidence on biomarkers used to predict poststroke functional recovery. Neurophysiological measurements and neuroimaging of the brain and a wide diversity of molecules had been used as prognostic biomarkers to predict stroke recovery. Neurophysiological studies using resting-state electroencephalography (EEG) revealed an interhemispheric asymmetry, driven by an increase in low-frequency oscillation and a decrease in high-frequency oscillation in the ipsilesional hemisphere relative to the contralesional side, which was indicative of individual recovery potential. The magnitude of somatosensory evoked potentials and event-related desynchronization elicited by movement in task-related EEG was positively associated with the quantity of recovery. Besides, transcranial magnetic stimulation (TMS) studies revealed the potential values of using motor-evoked potentials (MEP) and TMS-evoked EEG potentials from the ipsilesional motor cortex as prognostic biomarkers. Brain structures measured using magnetic resonance imaging (MRI) have been implicated in stroke outcome prediction. Specifically, the damage to the corticospinal tract (CST) and anatomical motor connections disrupted by stroke lesion predicted motor recovery. In addition, a wide variety of molecular, genetic, and epigenetic biomarkers, including hemostasis, inflammation, tissue remodeling, apoptosis, oxidative stress, infection, metabolism, brain-derived, neuroendocrine, and cardiac biomarkers, etc., were associated with poor functional outcomes after stroke. However, challenges such as mixed evidence and analytical concerns such as specificity and sensitivity have to be addressed before including molecular biomarkers in routine clinical practice. Potential biomarkers with prognostic values for the prediction of functional recovery after stroke have been identified; however, a multimodal approach of biomarkers for prognostic prediction has rarely been studied in the literature. Future studies may incorporate a combination of multiple biomarkers from big data and develop algorithms using data mining methods to predict the recovery potential of patients after stroke in a more precise way.

摘要

中风后恢复情况的预测可以通过与中风在细胞和分子水平的病理生理学以及在系统神经科学水平上中风后脑结构和功能储备相关的预后生物标志物来表示。本研究旨在综述能够预测中风后功能恢复的潜在生物标志物。进行了一项叙述性综述,以定性总结目前关于用于预测中风后功能恢复的生物标志物的证据。神经生理学测量、脑部神经影像学以及各种各样的分子已被用作预测中风恢复的预后生物标志物。使用静息态脑电图(EEG)的神经生理学研究揭示了一种半球间不对称性,其由患侧半球相对于对侧半球低频振荡增加和高频振荡减少所驱动,这表明了个体的恢复潜力。体感诱发电位的幅度以及任务相关脑电图中运动诱发的事件相关去同步化与恢复程度呈正相关。此外,经颅磁刺激(TMS)研究揭示了使用患侧运动皮层的运动诱发电位(MEP)和TMS诱发的脑电图电位作为预后生物标志物的潜在价值。使用磁共振成像(MRI)测量的脑结构与中风结局预测有关。具体而言,皮质脊髓束(CST)的损伤以及中风病变破坏的解剖学运动连接可预测运动恢复。此外,各种各样的分子、遗传和表观遗传生物标志物,包括止血、炎症、组织重塑、细胞凋亡、氧化应激、感染、代谢、脑源性、神经内分泌和心脏生物标志物等,都与中风后的不良功能结局相关。然而,在将分子生物标志物纳入常规临床实践之前,必须解决诸如证据混杂以及特异性和敏感性等分析方面的问题。已经确定了具有预测中风后功能恢复预后价值的潜在生物标志物;然而,文献中很少研究用于预后预测的生物标志物多模态方法。未来的研究可能会结合来自大数据的多种生物标志物,并使用数据挖掘方法开发算法,以更精确地预测中风后患者的恢复潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f17f/9868572/0a1c53f96685/fcell-10-1062807-g001.jpg

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