爆炸冲击波性脑损伤的发生机制和生物标志物研究进展

包昀禹 辛佳艳 张安强 王延江 卜先乐

包昀禹, 辛佳艳, 张安强, 王延江, 卜先乐. 爆炸冲击波性脑损伤的发生机制和生物标志物研究进展[J]. 爆炸与冲击, 2024, 44(12): 121412. doi: 10.11883/bzycj-2024-0179
引用本文: 包昀禹, 辛佳艳, 张安强, 王延江, 卜先乐. 爆炸冲击波性脑损伤的发生机制和生物标志物研究进展[J]. 爆炸与冲击, 2024, 44(12): 121412. doi: 10.11883/bzycj-2024-0179
BAO Yunyu, XIN Jiayan, ZHANG Anqiang, WANG Yanjiang, BU Xianle. Research progress on the pathogenesis and biomarkers of blast-induced traumatic brain injury[J]. Explosion And Shock Waves, 2024, 44(12): 121412. doi: 10.11883/bzycj-2024-0179
Citation: BAO Yunyu, XIN Jiayan, ZHANG Anqiang, WANG Yanjiang, BU Xianle. Research progress on the pathogenesis and biomarkers of blast-induced traumatic brain injury[J]. Explosion And Shock Waves, 2024, 44(12): 121412. doi: 10.11883/bzycj-2024-0179

爆炸冲击波性脑损伤的发生机制和生物标志物研究进展

doi: 10.11883/bzycj-2024-0179
基金项目: 军队高层次科技创新人才自主科研项目
详细信息
    作者简介:

    包昀禹(1994- ),女,硕士研究生,baoyunyu@tmmu.edu.cn

    通讯作者:

    卜先乐(1989- ),男,博士,副主任医师,副教授,buxianle@tmmu.edu.cn

  • 中图分类号: O383; R741

Research progress on the pathogenesis and biomarkers of blast-induced traumatic brain injury

  • 摘要: 爆炸冲击波性脑损伤(blast-induced traumatic brain injury,bTBI)是由爆炸时的冲击波对颅脑造成的损伤效应,伤者可表现出不同程度的躯体和行为障碍以及远期认知功能损害,是战时最常见的脑损伤类型。bTBI的发生机制复杂且尚未完全阐明。爆炸产生的冲击波作用于头部表面并在颅内传播,造成颅脑弥漫性损伤,从病理学层面可将bTBI分为原发性损伤和继发性损伤。冲击波的机械致伤效应会造成脑内结构的原发性受损,通常不可逆,只能采取有效的预防措施减少伤害。原发性损伤可引发一系列复杂的继发性级联反应,包括突触功能障碍、兴奋性毒性损伤、血脑屏障破坏、脑膜淋巴系统功能障碍、神经炎症、线粒体功能障碍、氧化应激反应、tau蛋白过度磷酸化和淀粉样蛋白-β病理改变等,可持续至伤后数天甚至慢性阶段,为临床治疗提供了干预的时间窗。轻度bTBI临床表现异质性高,影像学表现常呈阴性,早期诊断困难。但近年来bTBI的血液生物标志物取得长足进展,包括泛素C末端水解酶L1、神经元特异性烯醇化酶、神经丝蛋白轻链、磷酸化tau蛋白、髓鞘碱性蛋白、胶质纤维酸性蛋白、S100钙结合蛋白B和其他新兴生物标志物等,有望成为影像学阴性的bTBI的早期诊断和预后判断的潜在生物标志物。综上,本文重点综述了近年来关于bTBI的发生机制和生物标志物研究的前沿进展,并展望了未来的研究方向,以期为探索bTBI的发生机制、早期诊断策略和干预靶点提供新思路。
  • 图  1  bTBI主要病理过程和血液生物标志物

    Figure  1.  Main pathological processes and blood biomarkers of bTBI

    The black font sections represent the main pathological processes of bTBI, and the yellow font sections represent the potential blood biomarkers. This figure was drawn by Figdraw

    表  1  bTBI严重程度分级

    Table  1.   Classification of bTBI severity

    分级格拉斯哥昏迷量表意识丧失意识改变创伤后遗忘神经影像学表现
    轻度13~15分0~30 min≤24 h0~1 d正常
    中度9~12分30 min~24 h>24 h1~7 d正常或异常
    重度<9分>24 h>24 h>7 d正常或异常
    下载: 导出CSV
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