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临床表现 临床表现

Jesse Mez1, Brigid Dwyer1, Michael L Alosco1

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2021年创伤性脑病综合征 (TES) 标准显示,在现存个人中诊断慢性创伤性脑病 (CTE) 的可能性很大. 这些标准显示出良好的灵敏度和特异性,特别是在50岁以上的个体中.

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科学领域:

  • 神经病理学神经病理学
  • 神经科学是一个神经科学.
  • 临床神经学 临床神经学

背景情况:

  • 2021年国家神经障碍和中风研究所 (NINDS) 创伤性脑病综合征 (TES) 标准的有效性,用于诊断活人慢性创伤性脑病 (CTE) 的有效性以前没有被评估.
  • 评估这些标准对于推进CTE诊断和患者护理至关重要.

研究的目的:

  • 为了评估2021年NINDS TES标准的诊断准确性,在一个大脑捐赠者队列中,不同重复的头部冲击 (RHI) 和创伤性脑损伤 (TBI) 暴露.
  • 为了确定TES标准的敏感性,特异性和概率比率,与CTE的神经病理发现相比.

主要方法:

  • 从6个大脑银行和9个RHI/TBI暴露组中选择了大脑捐赠者,以及5个年龄组.
  • 神经病理学家对临床数据的盲目应用NINDS/NIBIB CTE神经病理学标准和分期 (I-IV).
  • 对神经病理学数据视而不见的临床医生使用告密者采访和医疗记录进行TES诊断 (暗示性,可能的,可能的).

主要成果:

  • 在193名大脑捐赠者中,29.5%符合TES (可能/可能的CTE) 的临床标准,21.8%符合CTEII-IV阶段的神经病理标准.
  • 总体TES标准的灵敏度为0.79和特异性为0.84,在50岁及以上的个体中精度更高 (灵敏度为0.93,特异性为0.90).
  • 假阳性包括I期CTE和其他神经退行性疾病;假阴性有暗示CTE,替代病因或不确定的过程.

结论:

  • 2021年TES标准显示了在多种RHI/TBI暴露中识别CTE病理的良好的灵敏度和特异性.
  • 这些标准在50岁以上的人群中特别有效,这表明它们在临床环境中具有潜在的实用性.
  • 这些发现支持在CTE的临床诊断中使用2021年TES标准的乐观情绪.