Potential biomarkers for hypoxic-ischemic encephalopathy.
Potential biomarkers for hypoxic-ischemic encephalopathy.
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DOI：
10.1016/j.siny.2010.05.007
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发表时间：
2010-10
影响因子：
3
通讯作者：
Gunn, A. J.
中科院分区：
文献类型：
--
作者：
Bennet, L.;Booth, L.;Gunn, A. J.
关键词：
脑低温可减少出生时缺氧缺血（HI）后的脑损伤并改善行为恢复。然而，使用目前的入学标准，许多婴儿没有得到帮助，相反，对照组的婴儿中有很大一部分存活下来，没有残疾。为了进一步改善治疗，我们需要更好的损伤生物标志物。一个“真正的”生物标志物，用于“可治疗的”损伤的发展阶段，将使我们不仅能够确定婴儿是否有损伤的风险，而且还能够确定他们是否仍然能够从干预中受益。即使是一种不太具体的措施，可以更准确地早期识别有不良神经发育结果风险的婴儿，也会减少试验结果的差异，提高试验功效，同时减少不必要治疗的婴儿数量。最后，治疗后长期结果的有效短期替代物将允许更快地完成初步评估，从而允许更快地测试新策略。实验研究表明，在继发性细胞死亡开始之前，有效治疗的“机会窗口”相对有限（HI后最多约6-8小时，“潜伏期”）。我们批判性地评估建议的生化，电子监测和成像生物标志物对这个框架的效用。这篇综述强调了目前大多数生物标志物的两个主要局限性：它们对已经很容易识别的严重损伤婴儿最精确，并且它们的相关性在潜伏期之后最强，此时损伤不再是“可治疗的”。这是进一步研究的一个重要领域。
Cerebral hypothermia reduces brain injury and improves behavioral recovery after hypoxia–ischemia (HI) at birth. However, using current enrolment criteria many infants are not helped, and conversely, a significant proportion of control infants survive without disability. In order to further improve treatment we need better biomarkers of injury. A ‘true’ biomarker for the phase of evolving, ‘treatable’ injury would allow us to identify not only whether infants are at risk of damage, but whether they are still able to benefit from intervention. Even a less specific measure that allowed either more precise early identification of infants at risk of adverse neurodevelopmental outcome would reduce the variance of outcome of trials, improving trial power while reducing the number of infants unnecessarily treated. Finally, valid short-term surrogates for long term outcome after treatment would allow more rapid completion of preliminary evaluation and thus allow new strategies to be tested more rapidly. Experimental studies have demonstrated that there is a relatively limited ‘window of opportunity’ for effective treatment (up to about 6–8 h after HI, the ‘latent phase’), before secondary cell death begins. We critically evaluate the utility of proposed biochemical, electronic monitoring, and imaging biomarkers against this framework. This review highlights the two central limitations of most presently available biomarkers: that they are most precise for infants with severe injury who are already easily identified, and that their correlation is strongest at times well after the latent phase, when injury is no longer ‘treatable’. This is an important area for further research.
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影响因子：
5.5
作者：
Bennet, L;Roelfsema, V;Gunn, AJ
通讯作者：
Gunn, AJ
影响因子：
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作者：
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作者：
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作者：
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通讯作者：
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DOI：
10.1097/00004647-199901000-00003
发表时间：
1999-01-01
影响因子：
6.3
作者：
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通讯作者：
Delpy, DT