慢性创伤性脑病的研究新进展

doi:10.3877/cma.j.issn.2095-9141.2023.06.008

慢性创伤性脑病（CTE）是一种经历反复颅脑损伤后导致的神经退行性变，以脑内Tau蛋白过度磷酸化异常积累为典型病理特征，由其引发的行为改变和认知障碍给患者的日常生活带来严重影响。目前对于CTE的病理学改变和临床表现展开了一系列研究，初步揭示了CTE的主要特征，并为临床诊断和治疗提供了许多有价值的线索。本文围绕CTE的发展历程、流行病学特征、病理学改变、临床诊断和治疗等方面的最新研究进展进行综述，旨在为CTE的深入研究和临床诊疗提供理论依据和新思路。

关键词: 慢性创伤性脑病, 颅脑损伤, 神经退行性疾病, Tau蛋白, 生物标志物

Chronic traumatic encephalopathy (CTE) is a kind of neurodegeneration caused by repeated cranio-cerebral injury, which is typically characterized by abnormal accumulation of Tau protein hyperphosphorylation in the brain. A series of studies have been conducted on the pathological changes and clinical manifestations of CTE, which have initially revealed the main features of CTE and provided many valuable clues for clinical diagnosis and treatment. This paper reviews the latest research progress in the development, epidemiological characteristics, pathological changes, clinical diagnosis and treatment of CTE, aiming to provide theoretical basis and new ideas for the in-depth research and clinical diagnosis and treatment of CTE.

Key words: Chronic traumatic encephalopathy, Craniocerebral injury, Neurodegenerative diseases, Tau protein, Biomarkers

表1 创伤性脑病综合征诊断标准

Tab.1 Diagnostic criteria for traumatic encephalopathy syndrome

TES诊断指标	标准
多次头部外伤史	损伤类型划分：脑震荡或轻型TBI（最少经历4次）；中度/重度TBI（最少经历2次）；无症状的头部外伤
	创伤暴露来源：对抗性运动（最少持续6年）、部队服役、其他反复颅脑损伤暴露史（例如家庭暴力等）
排除可产生类似症状的神经系统疾病	单次TBI或持续性PCS
排除可产生类似症状的神经系统疾病	药物滥用、创伤后应激障碍、情绪/焦虑障碍、其他神经退行性疾病
临床症状持续时间	至少持续12个月以上
至少有认知、行为、心理其中一种核心临床症状	认知：通过标准化的精神状态或认知神经心理测试获得的结果，要至少低于正常均值1.5个标准差
	行为：描述为破坏性行为、易怒、情绪失控、身体和（或）口头暴力，间歇性爆发性障碍情绪：过度悲伤、抑郁或绝望，诊断为重度抑郁症或持续性抑郁症
至少有2种伴随症状	症状持续加重1年、延迟发作（伤后2年以上）、冲动性、焦虑、淡漠、偏执、自杀倾向、头痛、运动障碍

表1 创伤性脑病综合征诊断标准

Tab.1 Diagnostic criteria for traumatic encephalopathy syndrome

TES诊断指标	标准
多次头部外伤史	损伤类型划分：脑震荡或轻型TBI（最少经历4次）；中度/重度TBI（最少经历2次）；无症状的头部外伤
	创伤暴露来源：对抗性运动（最少持续6年）、部队服役、其他反复颅脑损伤暴露史（例如家庭暴力等）
排除可产生类似症状的神经系统疾病	单次TBI或持续性PCS
排除可产生类似症状的神经系统疾病	药物滥用、创伤后应激障碍、情绪/焦虑障碍、其他神经退行性疾病
临床症状持续时间	至少持续12个月以上
至少有认知、行为、心理其中一种核心临床症状	认知：通过标准化的精神状态或认知神经心理测试获得的结果，要至少低于正常均值1.5个标准差
	行为：描述为破坏性行为、易怒、情绪失控、身体和（或）口头暴力，间歇性爆发性障碍情绪：过度悲伤、抑郁或绝望，诊断为重度抑郁症或持续性抑郁症
至少有2种伴随症状	症状持续加重1年、延迟发作（伤后2年以上）、冲动性、焦虑、淡漠、偏执、自杀倾向、头痛、运动障碍

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New advances in the study of chronic traumatic encephalopathy

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New advances in the study of chronic traumatic encephalopathy