Traumatic brain injuries
Traumatic brain injuries
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DOI：
10.1038/nrdp.2016.84
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发表时间：
2016-11-17
影响因子：
81.5
通讯作者：
Zetterberg, Henrik
中科院分区：
文献类型：
--
作者：
Blennow, Kaj;Brody, David L.;Zetterberg, Henrik
创伤性脑损伤（TBI）在临床上按严重程度分为：轻度、中度和重度。轻度TBI（最轻的形式）与脑震荡同义，通常由钝性非穿透性头部创伤引起。创伤引起轴突的拉伸和撕裂，这导致弥漫性轴突损伤-这种疾病的最佳研究的发病机制。然而，轻度TBI是根据临床基础定义的，并且没有经过充分验证的成像或流体生物标志物来确定轻度TBI患者中神经元损伤的存在。大多数轻度TBI患者会很快恢复，但其他人报告持续的症状，称为脑震荡后综合征，其潜在的病理生理学在很大程度上是未知的。反复的脑震荡和亚脑震荡性头部损伤与神经退行性疾病慢性创伤性脑病（CTE）有关，据报道，接触爆炸的接触性运动员和士兵在死后会出现这种情况。从严重损伤和CTE中获得的见解清楚地揭示了轻度TBI中涉及的潜在细胞和分子过程。MRI技术和轴突蛋白的血液测试，以确定和分级轴突损伤，除了PET的tau病理，显示出作为工具，以探索CTE的病理生理学在纵向临床研究的前景，并可能发展成为CTE的诊断工具。鉴于CTE是由于反复的头部创伤，预防可能是可能的，通过体育组织和立法者的规则变化。
Traumatic brain injuries (TBIs) are clinically grouped by severity: mild, moderate and severe. Mild TBI (the least severe form) is synonymous with concussion and is typically caused by blunt non-penetrating head trauma. The trauma causes stretching and tearing of axons, which leads to diffuse axonal injury - the best-studied pathogenetic mechanism of this disorder. However, mild TBI is defined on clinical grounds and no well-validated imaging or fluid biomarkers to determine the presence of neuronal damage in patients with mild TBI is available. Most patients with mild TBI will recover quickly, but others report persistent symptoms, called post-concussive syndrome, the underlying pathophysiology of which is largely unknown. Repeated concussive and subconcussive head injuries have been linked to the neurodegenerative condition chronic traumatic encephalopathy (CTE), which has been reported post-mortem in contact sports athletes and soldiers exposed to blasts. Insights from severe injuries and CTE plausibly shed light on the underlying cellular and molecular processes involved in mild TBI. MRI techniques and blood tests for axonal proteins to identify and grade axonal injury, in addition to PET for tau pathology, show promise as tools to explore CTE pathophysiology in longitudinal clinical studies, and might be developed into diagnostic tools for CTE. Given that CTE is attributed to repeated head trauma, prevention might be possible through rule changes by sports organizations and legislators.