Hardaker Natalie, King Doug, Hume Patria A, Stewart Tom, Sims Stacy, Basu Indira, Shilton Blair, Selfe James
Faculty of Health and Environmental Science, Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, New Zealand Wellington, New Zealand.
Accident Compensation Corporation, Wellington, New Zealand.
BMC Neurol. 2024 May 2;24(1):149. doi: 10.1186/s12883-024-03653-9.
Females of reproductive age with concussion report a greater number of symptoms that can be more severe and continue for longer than age matched males. Underlying mechanisms for sex differences are not well understood. Short non-coding Ribonucleic Acids (sncRNAs) are candidate salivary biomarkers for concussion and have been studied primarily in male athletes. Female sex hormones influence expression of these biomarkers, and it remains unclear whether a similar pattern of sncRNA expression would be observed in females following concussion. This study aims to evaluate recovery time, the ratio of salivary sncRNAs and symptom severity across different hormone profiles in females presenting to emergency departments (ED) with concussion and, to investigate the presence of low energy availability (LEA) as a potential modifier of concussion symptoms.
This prospective cohort study recruits participants from New Zealand EDs who are biologically female, of reproductive age (16-50 years) and with a confirmed diagnosis of concussion from an ED healthcare professional. Participants are excluded by ED healthcare professionals from study recruitment as part of initial routine assessment if they have a pre-diagnosed psychiatric condition, neurological condition (i.e., epilepsy, cerebral palsy) or more than three previously diagnosed concussions. Participants provide a saliva sample for measurement of sncRNA's, and online survey responses relating to hormone profile and symptom recovery at 7-day intervals after injury until they report a full return to work/study. The study is being performed in accordance with ethical standards of the Declaration of Helsinki with ethics approval obtained from the Health and Disability Ethics Committee (HDEC #2021 EXP 11655), Auckland University of Technology Ethics Committee (AUTEC #22/110) and locality consent through Wellington hospital research office.
If saliva samples confirm presence of sncRNAs in females with concussion, it will provide evidence of the potential of saliva sampling as an objective tool to aid in diagnosis of, and confirmation of recovery from, concussion. Findings will determine whether expression of sncRNAs is influenced by steroid hormones in females and may outline the need for sex specific application and interpretation of sncRNAs as a clinical and/or research tool.
Australian New Zealand Clinical Trials Registry (ANZCTR) registration number ACTRN12623001129673.
患有脑震荡的育龄女性报告的症状数量更多，症状可能更严重，且持续时间比年龄匹配的男性更长。性别差异的潜在机制尚未完全明确。短链非编码核糖核酸（sncRNAs）是脑震荡的候选唾液生物标志物，此前主要在男性运动员中进行研究。女性性激素会影响这些生物标志物的表达，目前尚不清楚脑震荡后的女性是否会出现类似的sncRNA表达模式。本研究旨在评估因脑震荡前往急诊科（ED）就诊的女性在不同激素水平下的恢复时间、唾液sncRNAs比值和症状严重程度，并调查低能量可用性（LEA）作为脑震荡症状潜在调节因素的存在情况。
这项前瞻性队列研究从新西兰急诊科招募生物学意义上的育龄女性（16 - 50岁），且经急诊科医疗专业人员确诊为脑震荡。如果参与者预先被诊断患有精神疾病、神经系统疾病（如癫痫、脑瘫）或之前有超过三次脑震荡诊断，急诊科医疗专业人员会在初始常规评估时将其排除在研究招募范围之外。参与者提供唾液样本用于测量sncRNAs，并在受伤后每隔7天通过在线调查回复激素水平和症状恢复情况，直至报告完全恢复工作/学习。本研究按照《赫尔辛基宣言》的伦理标准进行，已获得健康与残疾伦理委员会（HDEC #2021 EXP 11655）、奥克兰理工大学伦理委员会（AUTEC #22/110）的伦理批准，并通过惠灵顿医院研究办公室获得当地同意。
如果唾液样本证实脑震荡女性中存在sncRNAs，将为唾液采样作为辅助脑震荡诊断和确认恢复情况的客观工具的潜力提供证据。研究结果将确定女性中sncRNAs的表达是否受类固醇激素影响，并可能概述将sncRNAs作为临床和/或研究工具进行性别特异性应用和解读的必要性。
澳大利亚新西兰临床试验注册中心（ANZCTR）注册号ACTRN12623001129673。
