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

[1]	GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the global burden of disease study 2016[J]. Lancet Neurol, 2019, 18(5): 459-480. DOI: 10.1016/s1474-4422(18)30499-x.
[2]	Blennow K, Brody DL, Kochanek PM, et al. Traumatic brain injuries[J]. Nat Rev Dis Primers, 2016, 2: 16084. DOI: 10.1038/nrdp.2016.84.
[3]	Graham NS, Sharp DJ. Understanding neurodegeneration after traumatic brain injury: from mechanisms to clinical trials in dementia[J]. J Neurol Neurosurg Psychiatry, 2019, 90(11): 1221-1233. DOI: 10.1136/jnnp-2017-317557.
[4]	Wilson L, Stewart W, Dams-O'Connor K, et al. The chronic and evolving neurological consequences of traumatic brain injury[J]. Lancet Neurol, 2017, 16(10): 813-825. DOI: 10.1016/s1474-4422(17)30279-x.
[5]	Smith DH, Dollé JP, Ameen-Ali KE, et al. Collaborative neuropathology network characterizing outcomes of TBI (connect-TBI)[J]. Acta Neuropathol Commun, 2021, 9(1): 32. DOI: 10.1186/s40478-021-01122-9.
[6]	Schwab N, Wennberg R, Grenier K, et al. Association of position played and career duration and chronic traumatic encephalopathy at autopsy in elite football and hockey players[J]. Neurology, 2021, 96(14): e1835-e1843. DOI: 10.1212/wnl.0000000000011668.
[7]	Martland HS. Punch drunk[J]. J Am Med Assoc, 1928, 91(15): 1103-1107. DOI: 10.1001/jama.1928.02700150029009.
[8]	Gavett BE, Stern RA, McKee AC. Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma[J]. Clin Sports Med, 2011, 30(1): 179-188, xi. DOI: 10.1016/j.csm.2010.09.007.
[9]	Corsellis JA, Bruton CJ, Freeman-Browne D. The aftermath of boxing[J]. Psychol Med, 1973, 3(3): 270-303. DOI: 10.1017/s0033291700049588.
[10]	Omalu BI, DeKosky ST, Minster RL, et al. Chronic traumatic encephalopathy in a national football league player[J]. Neurosurgery, 2005, 57(1): 128-134; discussion 128-134. DOI: 10.1227/01.neu.0000163407.92769.ed.
[11]	Lee EB, Kinch K, Johnson VE, et al. Chronic traumatic encephalopathy is a common co-morbidity, but less frequent primary dementia in former soccer and rugby players[J]. Acta Neuropathol, 2019, 138(3): 389-399. DOI: 10.1007/s00401-019-02030-y.
[12]	McKee AC, Cairns NJ, Dickson DW, et al. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy[J]. Acta Neuropathol, 2016, 131(1): 75-86. DOI: 10.1007/s00401-015-1515-z.
[13]	Bieniek KF, Cairns NJ, Crary JF, et al. The second NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy[J]. J Neuropathol Exp Neurol, 2021, 80(3): 210-219. DOI: 10.1093/jnen/nlab001.
[14]	Nowinski CJ, Bureau SC, Buckland ME, et al. Applying the Bradford Hill criteria for causation to repetitive head impacts and chronic traumatic encephalopathy[J]. Front Neurol, 2022, 13: 938163. DOI: 10.3389/fneur.2022.938163.
[15]	Aaronson AL, Bordelon SD, Brakel SJ, et al. A review of the role of chronic traumatic encephalopathy in criminal court[J]. J Am Acad Psychiatry Law, 2021, 49(1): 60-65. DOI: 10.29158/jaapl.200054-20.
[16]	Smith DH, Johnson VE, Trojanowski JQ, et al. Chronic traumatic encephalopathy-confusion and controversies[J]. Nat Rev Neurol, 2019, 15(3): 179-183. DOI: 10.1038/s41582-018-0114-8.
[17]	Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players[J]. Neurosurgery, 2005, 57(4): 719-726; discussion 719-726. DOI: 10.1093/neurosurgery/57.4.719.
[18]	Lehman EJ, Hein MJ, Baron SL, et al. Neurodegenerative causes of death among retired National Football League players[J]. Neurology, 2012, 79(19): 1970-1974. DOI: 10.1212/WNL.0b013e31826daf50.
[19]	Plassman BL, Havlik RJ, Steffens DC, et al. Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias[J]. Neurology, 2000, 55(8): 1158-1166. DOI: 10.1212/wnl.55.8.1158.
[20]	Beach TG, Monsell SE, Phillips LE, et al. Accuracy of the clinical diagnosis of Alzheimer disease at national institute on aging Alzheimer disease centers, 2005-2010[J]. J Neuropathol Exp Neurol, 2012, 71(4): 266-273. DOI: 10.1097/NEN.0b013e31824b211b.
[21]	Sayed N, Culver C, Dams-O'Connor K, et al. Clinical phenotype of dementia after traumatic brain injury[J]. J Neurotrauma, 2013, 30(13): 1117-1122. DOI: 10.1089/neu.2012.2638.
[22]	McKee AC, Stern RA, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy[J]. Brain, 2013, 136(Pt 1): 43-64. DOI: 10.1093/brain/aws307.
[23]	Iverson GL, Gardner AJ, Shultz SR, et al. Chronic traumatic encephalopathy neuropathology might not be inexorably progressive or unique to repetitive neurotrauma[J]. Brain, 2019, 142(12): 3672-3693. DOI: 10.1093/brain/awz286.
[24]	Wang D, Huang X, Yan L, et al. The structure biology of tau and clue for aggregation inhibitor design[J]. Protein J, 2021, 40(5): 656-668. DOI: 10.1007/s10930-021-10017-6.
[25]	Sinsky J, Pichlerova K, Hanes J. Tau protein interaction partners and their roles in Alzheimer's disease and other tauopathies[J]. Int J Mol Sci, 2021, 22(17). DOI: 10.3390/ijms22179207.
[26]	McKee AC. The neuropathology of chronic traumatic encephalopathy: the status of the literature[J]. Semin Neurol, 2020, 40(4): 359-369. DOI: 10.1055/s-0040-1713632.
[27]	Tziortzouda P, Van Den Bosch L, Hirth F. Triad of TDP43 control in neurodegeneration: autoregulation, localization and aggregation[J]. Nat Rev Neurosci, 2021, 22(4): 197-208. DOI: 10.1038/s41583-021-00431-1.
[28]	Yang C, Nag S, Xing G, et al. A clinicopathological report of a 93-year-old former street boxer with coexistence of chronic traumatic encephalopathy, Alzheimer's disease, dementia with lewy bodies, and hippocampal sclerosis with TDP-43 pathology[J]. Front Neurol, 2020, 11: 42. DOI: 10.3389/fneur.2020.00042.
[29]	Nicks R, Clement NF, Alvarez VE, et al. Repetitive head impacts and chronic traumatic encephalopathy are associated with TDP-43 inclusions and hippocampal sclerosis[J]. Acta Neuropathol, 2023, 145(4): 395-408. DOI: 10.1007/s00401-023-02539-3.
[30]	Kelly JP, Priemer DS, Perl DP, et al. Sports concussion and chronic traumatic encephalopathy: finding a path forward[J]. Ann Neurol, 2023, 93(2): 222-225. DOI: 10.1002/ana.26566.
[31]	Zetterberg H, Winblad B, Bernick C, et al. Head trauma in sports-clinical characteristics, epidemiology and biomarkers[J]. J Intern Med, 2019, 285(6): 624-634. DOI: 10.1111/joim.12863.
[32]	Montenigro PH, Baugh CM, Daneshvar DH, et al. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome[J]. Alzheimers Res Ther, 2014, 6(5): 68. DOI: 10.1186/s13195-014-0068-z.
[33]	Pavlovic D, Pekic S, Stojanovic M, et al. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae[J]. Pituitary, 2019, 22(3): 270-282. DOI: 10.1007/s11102-019-00957-9.
[34]	Filley CM. White matter dementia then… and now[J]. Front Neurol, 2022, 13: 1043583. DOI: 10.3389/fneur.2022.1043583.
[35]	Jain V, de Godoy LL, Mohan S, et al. Cerebral hemodynamic and metabolic dysregulation in the postradiation brain[J]. J Neuroimaging, 2022, 32(6): 1027-1043. DOI: 10.1111/jon.13053.
[36]	Chen JJ, Gauthier CJ. The role of cerebrovascular-reactivity mapping in functional MRI: calibrated fMRI and resting-state fMRI[J]. Front Physiol, 2021, 12: 657362. DOI: 10.3389/fphys.2021.657362.
[37]	Bonfante E, Riascos R, Arevalo O. Imaging of chronic concussion[J]. Neuroimaging Clin N Am, 2018, 28(1): 127-135. DOI: 10.1016/j.nic.2017.09.011.
[38]	Carmichael O, Schwarz AJ, Chatham CH, et al. The role of fMRI in drug development[J]. Drug Discov Today, 2018, 23(2): 333-348. DOI: 10.1016/j.drudis.2017.11.012.
[39]	Ayubcha C, Revheim ME, Newberg A, et al. A critical review of radiotracers in the positron emission tomography imaging of traumatic brain injury: FDG, tau, and amyloid imaging in mild traumatic brain injury and chronic traumatic encephalopathy[J]. Eur J Nucl Med Mol Imaging, 2021, 48(2): 623-641. DOI: 10.1007/s00259-020-04926-4.
[40]	Huang CX, Li YH, Lu W, et al. Positron emission tomography imaging for the assessment of mild traumatic brain injury and chronic traumatic encephalopathy: recent advances in radiotracers[J]. Neural Regen Res, 2022, 17(1): 74-81. DOI: 10.4103/1673-5374.314285.
[41]	Omalu B, Small GW, Bailes J, et al. Postmortem autopsy-confirmation of antemortem [F-18] FDDNP-PET scans in a football player with chronic traumatic encephalopathy[J]. Neurosurgery, 2018, 82(2): 237-246. DOI: 10.1093/neuros/nyx536.
[42]	Marquié M, Agüero C, Amaral AC, et al. [¹⁸F]-AV-1451 binding profile in chronic traumatic encephalopathy: a postmortem case series[J]. Acta Neuropathol Commun, 2019, 7(1): 164. DOI: 10.1186/s40478-019-0808-1.
[43]	Stern RA, Adler CH, Chen K, et al. Tau positron-emission tomography in former national football league players[J]. N Engl J Med, 2019, 380(18): 1716-1725. DOI: 10.1056/NEJMoa1900757.
[44]	Graham NSN, Zimmerman KA, Bertolini G, et al. Multicentre longitudinal study of fluid and neuroimaging BIOmarkers of AXonal injury after traumatic brain injury: the BIO-AX-TBI study protocol[J]. BMJ Open, 2020, 10(11): e042093. DOI: 10.1136/bmjopen-2020-042093.
[45]	Hier DB, Obafemi-Ajayi T, Thimgan MS, et al. Blood biomarkers for mild traumatic brain injury: a selective review of unresolved issues[J]. Biomark Res, 2021, 9(1): 70. DOI: 10.1186/s40364-021-00325-5.
[46]	McDonald SJ, O'Brien WT, Symons GF, et al. Prolonged elevation of serum neurofilament light after concussion in male australian football players[J]. Biomark Res, 2021, 9(1): 4. DOI: 10.1186/s40364-020-00256-7.
[47]	Laverse E, Guo T, Zimmerman K, et al. Plasma glial fibrillary acidic protein and neurofilament light chain, but not tau, are biomarkers of sports-related mild traumatic brain injury[J]. Brain Commun, 2020, 2(2): fcaa137. DOI: 10.1093/braincomms/fcaa137.
[48]	Guedes VA, Kenney K, Shahim P, et al. Exosomal neurofilament light: a prognostic biomarker for remote symptoms after mild traumatic brain injury?[J]. Neurology, 2020, 94(23): e2412-e2423. DOI: 10.1212/wnl.0000000000009577.
[49]	Ghaith HS, Nawar AA, Gabra MD, et al. A literature review of traumatic brain injury biomarkers[J]. Mol Neurobiol, 2022, 59(7): 4141-4158. DOI: 10.1007/s12035-022-02822-6.
[50]	Muraoka S, Jedrychowski MP, Tatebe H, et al. Proteomic profiling of extracellular vesicles isolated from cerebrospinal fluid of former national football league players at risk for chronic traumatic encephalopathy[J]. Front Neurosci, 2019, 13: 1059. DOI: 10.3389/fnins.2019.01059.
[51]	Shahim P, Tegner Y, Marklund N, et al. Neurofilament light and tau as blood biomarkers for sports-related concussion[J]. Neurology, 2018, 90(20): e1780-e1788. DOI: 10.1212/wnl.0000000000005518.
[52]	Amoo M, Henry J, O'halloran P J, et al. S100B, GFAP, UCH-L1 and NSE as predictors of abnormalities on CT imaging following mild traumatic brain injury: a systematic review and meta-analysis of diagnostic test accuracy[J]. Neurosurg Rev, 2022, 45(2): 1171-1193. DOI: 10.1007/s10143-021-01678-z.
[53]	Shen J, Xin W, Li Q, et al. Methylene blue reduces neuronal apoptosis and improves blood-brain barrier integrity after traumatic brain injury[J]. Front Neurol, 2019, 10: 1133. DOI: 10.3389/fneur.2019.01133.
[54]	Laurent C, Buée L, Blum D. Tau and neuroinflammation: what impact for Alzheimer's disease and tauopathies?[J]. Biomed J, 2018, 41(1): 21-33. DOI: 10.1016/j.bj.2018.01.003.
[55]	Tian Z, Feng B, Wang XQ, et al. Focusing on cyclin-dependent kinases 5: a potential target for neurological disorders[J]. Front Mol Neurosci, 2022, 15: 1030639. DOI: 10.3389/fnmol.2022.1030639.
[56]	Wang S, Jiang Y, Liu Y, et al. Ferroptosis promotes microtubule-associated protein tau aggregation via GSK-3β activation and proteasome inhibition[J]. Mol Neurobiol, 2022, 59(3): 1486-1501. DOI: 10.1007/s12035-022-02731-8.
[57]	Rubenstein R, Sharma DR, Chang B, et al. Novel mouse tauopathy model for repetitive mild traumatic brain injury: evaluation of long-term effects on cognition and biomarker levels after therapeutic inhibition of tau phosphorylation[J]. Front Neurol, 2019, 10: 124. DOI: 10.3389/fneur.2019.00124.
[58]	Kabadi SV, Stoica BA, Byrnes KR, et al. Selective CDK inhibitor limits neuroinflammation and progressive neurodegeneration after brain trauma[J]. J Cereb Blood Flow Metab, 2012, 32(1): 137-149. DOI: 10.1038/jcbfm.2011.117.
[59]	Osama A, Zhang J, Yao J, et al. Nrf2: A dark horse in Alzheimer's disease treatment[J]. Ageing Res Rev, 2020, 64: 101206. DOI: 10.1016/j.arr.2020.101206.
[60]	Rouhani M, Hadi-Alijanvand H. Effect of lithium drug on binding affinities of glycogen synthase kinase-3 β to its network partners: a new computational approach[J]. J Chem Inf Model, 2021, 61(10): 5280-5292. DOI: 10.1021/acs.jcim.1c00952.
[61]	Thapa K, Khan H, Singh TG, et al. Traumatic brain injury: mechanistic insight on pathophysiology and potential therapeutic targets[J]. J Mol Neurosci, 2021, 71(9): 1725-1742. DOI: 10.1007/s12031-021-01841-7.
[62]	Sen T, Saha P, Sen N. Nitrosylation of GAPDH augments pathological tau acetylation upon exposure to amyloid-β[J]. Sci Signal, 2018, 11(522): eaao6765. DOI: 10.1126/scisignal.aao6765.
[63]	Shin M K, Vázquez-Rosa E, Koh Y, et al. Reducing acetylated tau is neuroprotective in brain injury[J]. Cell, 2021, 184(10): 2715-2732.e23. DOI: 10.1016/j.cell.2021.03.032.
[64]	Kumar V, Kundu S, Singh A, et al. Understanding the role of histone deacetylase and their inhibitors in neurodegenerative disorders: current targets and future perspective[J]. Curr Neuropharmacol, 2022, 20(1): 158-178. DOI: 10.2174/1570159X19666210609160017.
[65]	Sacramento C B, Sondhi D, Rosenberg J B, et al. Anti-phospho-tau gene therapy for chronic traumatic encephalopathy[J]. Hum Gene Ther, 2020, 31(1-2): 57-69. DOI: 10.1089/hum.2019.174.
[66]	Alipour M, Tebianian M, Tofigh N, et al. Active immunotherapy against pathogenic Cis pT231-tau suppresses neurodegeneration in traumatic brain injury mouse models[J]. Neuropeptides, 2022, 96: 102285. DOI: 10.1016/j.npep.2022.102285.
[67]	Nobuhara CK, Devos SL, Commins C, et al. Tau antibody targeting pathological species blocks neuronal uptake and interneuron propagation of tau in vitro[J]. Am J Pathol, 2017, 187(6): 1399-1412. DOI: 10.1016/j.ajpath.2017.01.022.
[68]	Cockerell O C, Iino Hayes N, Sylvester R. The neurological risks of playing association football[J]. JRSM Open, 2021, 12(11): 20542704211055558. DOI: 10.1177/20542704211055558.
[69]	Fesharaki-Zadeh A. Chronic traumatic encephalopathy: a brief overview[J]. Front Neurol, 2019, 10: 713. DOI: 10.3389/fneur.2019.00713.
[70]	Hubertus V, Marklund N, Vajkoczy P. Management of concussion in soccer[J]. Acta Neurochir (Wien), 2019, 161(3): 425-433. DOI: 10.1007/s00701-019-03807-6.

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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