创伤性颅脑损伤患者预后评估与预测：伤情特征、生物标志物及临床工具的研究进展与挑战

Prognostic Assessment and Prediction in Patients with Traumatic Brain Injury: Research Progress and Challenges in Injury Characteristics, Biomarkers, and Clinical Tools

摘要: 创伤性颅脑损伤(TBI)的预后评估亟需多模态指标协同优化。本文叙述性综述表明：1) 伤情特征中，动态格拉斯哥昏迷评分(GCS)、Rotterdam CT评分(>3分时死亡率增加40%)及弥散张量成像各向异性分数(DTI-FA，胼胝体FA < 0.6预示认知障碍)构成预后分层基础；2) 生物标志物方面，胶质纤维酸性蛋白(GFAP，AUC = 0.82预测颅内病变)与泛素C末端水解酶-L1 (UCH-L1，高值者死亡风险增加2.5倍)主导神经损伤评估，而中性粒细胞/白蛋白比值(NAR)作为新兴炎症标志物，显著提升死亡风险识别效能(NAR > 5.2时死亡风险增加3.1倍，P < 0.01)；3) 临床工具中，IMPACT模型整合NAR后曲线下面积(AUC)提升至0.91 (ΔAUC = +0.07)。当前挑战集中于NAR阈值年龄依赖性、低白蛋白血症干扰及多模态临床整合不足，未来需构建“伤情–神经损伤–炎症监测”动态框架，推动NAR指导的靶向干预。

Abstract: The prognosis assessment of traumatic brain injury (TBI) is in urgent need of collaborative optimization of multimodal indicators. This systematic review shows that: 1) Among the injury characteristics, the dynamic Glasgow Coma Scale (GCS), Rotterdam CT score (a score > 3 is associated with a 40% increase in mortality), and fractional anisotropy from diffusion tensor imaging (DTI-FA, with corpus callosum FA < 0.6 predicting cognitive impairment) form the basis for prognostic stratification; 2) In terms of biomarkers, glial fibrillary acidic protein (GFAP, with an AUC of 0.82 for predicting intracranial lesions) and ubiquitin C-terminal hydrolase-L1 (UCH-L1, with high values associated with a 2.5-fold increase in the risk of death) dominate the assessment of neurological injury. Additionally, the neutrophil/albumin ratio (NAR), as an emerging inflammatory marker, significantly enhances the ability to identify death risk (a NAR > 5.2 is associated with a 3.1-fold increase in death risk, P < 0.01); 3) Among clinical tools, the area under the curve (AUC) of the IMPACT model increased to 0.91 (ΔAUC = +0.07) after integrating NAR. Current challenges focus on the age dependence of the NAR threshold, interference from hypoalbuminemia, and insufficient clinical integration of multimodal data. In the future, it is necessary to construct a dynamic framework of “injury condition - neurological injury - inflammation monitoring” to promote NAR-guided targeted interventions.