University of Massachusetts Chan Medical School TH Chan School of Medicine, Worcester, Massachusetts, USA.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Neurol Neurosurg Psychiatry. 2024 Jan 11;95(2):184-192. doi: 10.1136/jnnp-2023-331220.
Despite approximately 55.9 million annual mild traumatic brain injuries (mTBIs) worldwide, the accurate diagnosis of mTBI continues to challenge clinicians due to symptom ambiguity, reliance on subjective report and presentation variability. Non-invasive fluid biomarkers of mTBI offer a biological measure to diagnose and monitor mTBI without the need for blood draws or neuroimaging. The objective of this study is to systematically review the utility of such biomarkers to diagnose mTBI and predict disease progression.
A systematic review performed in PubMed, Scopus, Cochrane and Web of Science followed by a manual search of references without a specified timeframe. Search strings were generated and run (27 June 2022) by a research librarian. Studies were included if they: (1) included human mTBI subjects, (2) assessed utility of a non-invasive biomarker and (3) published in English. Exclusion criteria were (1) non-mTBI subjects, (2) mTBI not assessed separately from moderate/severe TBI, (3) required intracranial haemorrhage or (4) solely assesses genetic susceptibility to mTBI.
A total of 29 studies from 27 subject populations (1268 mTBI subjects) passed the inclusion and exclusion criteria. Twelve biomarkers were studied. Salivary RNAs, including microRNA, were assessed in 11 studies. Cortisol and melatonin were assessed in four and three studies, respectively. Eight salivary and two urinary biomarkers contained diagnostic or disease monitoring capability.
This systematic review identified several salivary and urinary biomarkers that demonstrate the potential to be used as a diagnostic, prognostic and monitoring tool for mTBI. Further research should examine miRNA-based models for diagnostic and predictive utility in patients with mTBI.
CRD42022329293.
尽管全球每年有大约 5590 万例轻度创伤性脑损伤（mTBI），但由于症状模糊、依赖主观报告和表现变异性，mTBI 的准确诊断仍然对临床医生构成挑战。mTBI 的非侵入性液体生物标志物提供了一种生物学测量方法，可用于诊断和监测 mTBI，而无需进行血液采集或神经影像学检查。本研究的目的是系统回顾这些生物标志物在诊断 mTBI 和预测疾病进展方面的效用。
在 PubMed、Scopus、Cochrane 和 Web of Science 中进行系统回顾，然后手动搜索参考文献，没有指定时间范围。研究图书馆员生成并运行了搜索字符串（2022 年 6 月 27 日）。如果研究符合以下标准，则纳入：（1）包括人类 mTBI 受试者，（2）评估非侵入性生物标志物的效用，（3）以英文发表。排除标准为：（1）非 mTBI 受试者，（2）mTBI 未单独评估中度/重度 TBI，（3）需要颅内出血，（4）仅评估 mTBI 的遗传易感性。
共有 29 项研究来自 27 个人群（1268 例 mTBI 受试者）通过了纳入和排除标准。研究了 12 种生物标志物。11 项研究评估了唾液 RNA，包括 microRNA。四项和三项研究分别评估了皮质醇和褪黑素。八种唾液和两种尿液生物标志物具有诊断或疾病监测能力。
本系统回顾确定了几种唾液和尿液生物标志物，它们具有作为 mTBI 诊断、预后和监测工具的潜力。进一步的研究应检查基于 miRNA 的模型在 mTBI 患者中的诊断和预测效用。
PROSPERO 注册号：CRD42022329293。
