国际麻醉学与复苏杂志   2018, Issue (6): 4-4
    
生物标志物在创伤性脑损伤临床鉴别诊断中的应用
曹红玲, 郭悦平, 王跃振, 李爱民, 杨万超, 李文志1()
1.哈尔滨医科大学附属第二医院
Biomarkers for the clinical differential diagnosis of traumatic brain injury
 全文:
摘要:

背景 创伤性脑损伤(traumatic brain injury, TBI)是当今社会青年人死亡和致残的主要原因之一,这无疑给社会造成了巨大的经济和医疗负担,但是脑创伤在临床治疗中却是极其复杂的。如何尽早准确地判断TBI的严重程度对治疗和预后尤为重要,生物标志物在其中发挥着积极作用。 目的 正是由于脑创伤病理过程的复杂性和多样性,所以才致力于寻找能够评价脑创伤病情及预后的新方法。通过检测脑创伤患者体液中的一些特异性和敏感性高的生物标志物来提高脑创伤的诊断能力,评估创伤后颅内的病理变化,从而有助于患者的管理和治疗。 内容 主要总结近些年来与TBI相关的生物标志物及其在临床评判TBI预后中的作用。主要包括当下的研究热点[S100β、胶质纤维酸性蛋白(glial fibrillary acidic protein, GFAP)、神经元特异性烯醇化酶(neuron-specific enolase, NSE)、髓磷脂碱性蛋白(myelin basic protein, MBP)、神经丝(neurofilaments, NFs)、C-Tau、微管结合蛋白2(microtubule-associated protein 2, MAP2)、泛素C端水解酶L1(ubiquitin c-terminal hydrolase-L1, UCHL1)、α-Ⅱ血影蛋白分解产物(α-Ⅱ spectrin breakdown product, SBDP)]和一些新兴的生物标志物[微RNA(microRNA, miRNA)、脂肪酸结合蛋白(fatty acid blinding proteins, FABPs)、血浆铜蓝蛋白、C反应蛋白(C-reactive protein, CRP)、基质金属蛋白酶-2(matrix metalloproteinase-2, MMP-2)]。 趋向 生物标志物已经在一些疾病诊断方面显示出潜能,如癌症、心力衰竭、感染和家族遗传疾病等。检查一种疾病特异性的生物标志物,对于疾病的鉴定、早期诊断和预防、治疗过程中的监控可能起到帮助作用。目前,对于脑创伤的研究主要致力于寻找能够提高预测能力的生物标志物。

关键词: 创伤性脑损伤; 生物标志物
Abstract:

Background Traumatic brain injury(TBI), as one of the leading causes of death and disability in young people, laid a huge economic and healthcare burden on our society. But lack of biomarkers to evaluate the severity of TBI poses challenges to effectively treat this disease, therefore, the prognosis of TBI is unpredictable. Objective To review studies in examining trauma-related molecules in body fluid of TBI patients, and analyzing the relationship of individual molecules with pathological alterations, correct diagnosis, therapeutic strategies, and varying prognosis. Content This paper summarizes currently available biomarkers associated with the clinical prognosis of TBI. Glial fibrillary acidic protein(GFAP) is a biomarker for primary brain injury, and in combination with S100β, it is valuable to predict the prognosis of TBI. The increase of the levels of ubiquitin c-terminal hydrolase-L1(UCHL1) and α-Ⅱ spectrin breakdown product(SBDP) can improve the identification of the severity of brain injury and the prognosis of TBI. Neurofilaments(NFs), S100β, GFAP, and UCHL1 are useful to define local or disseminated brain injury. The levels of C-Tau, neuron-specific enolase(NSE), GFAP, and SBDPs may be associated with the increase of intracranial pressure. Further investigations should be conducted to confirm the roles of some molecules, such as miRNAs, fatty acid binding proteins (FABPs), C-reactive protein(CRP), and matrix metalloproteinase-2(MMP-2), as biomarkers of TBI. Trend The combination of multiple abovementioned biomarkers, although lack of specificity, are helpful for the diagnosis of TBI. Integrating these information with other clinical examinations, such as psychological assay, GLAS score, and computerized topography, may improve the diagnosis of TBI, and provide valuable basis for designing effective therapeutic strategies.

Key words: Traumatic brain injury; Biomarkers