中国神经再生研究(英文版) ›› 2026, Vol. 21 ›› Issue (3): 887-907.doi: 10.4103/NRR.NRR-D-24-01398

• 综述:脑损伤修复保护与再生 • 上一篇    下一篇

创伤性脑损伤:病理生理学机制认识与精准治疗策略

  

  • 出版日期:2026-03-15 发布日期:2025-07-01
  • 基金资助:
    此研究得到了军队后勤开放科研项目 (BLB20J009)的资助。

Traumatic brain injury: Bridging pathophysiological insights and precision treatment strategies

Yujia Lu1, 2, #, Jie Jin1, 2, #, Huajing Zhang1, 2, #, Qianying Lu1, 2, Yingyi Zhang1, 2, Chuanchuan Liu1, 2, Yangfan Liang1, 2, Sijia Tian1, 2, Yanmei Zhao1, 2, *, Haojun Fan1, 2, *   

  1. 1 School of Disaster and Emergency Medicine, Tianjin University, Tianjin, China;  2 Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
  • Online:2026-03-15 Published:2025-07-01
  • Contact: Yanmei Zhao, PhD, zhaoyanmei@tju.edu.cn; Haojun Fan, PhD, haojunfan86@163.com.
  • Supported by:
    This work was supported by Open Scientific Research Program of Military Logistics, No. BLB20J009 (to YZhao).

摘要:

血脑屏障破坏和神经炎症反应是创伤性脑损伤尤为突出的病理特征,对创伤性脑损伤疾病进展和治疗效果有着至关重要的影响。此综述阐述了目前对创伤性脑损伤中血脑屏障破坏和神经炎症之间双向关系的认识,以及创伤性脑损伤的新治疗策略。文献结果显示,创伤性脑损伤后,血脑屏障破坏和神经炎症反应是关键的病理特征。创伤性脑损伤后的急性期的病理特点是原发性血脑屏障破坏和炎症级联激活,亚急性期的病理特点是修复机制和炎症调节,慢性期的病理特点表现出持续的低度炎症和不完全的血脑屏障恢复。血脑屏障的结构改变、炎症级联、细胞外基质重塑等多种生理变化相互影响,受遗传、年龄、性别和环境因素作用。血脑屏障通透性与神经炎症之间的动态平衡受到激素调节,尤其是性激素和压力激素的影响,此外,胃肠激素的作用也日益受到关注。目前的创伤性脑损伤治疗策略包括传统药物治疗、多模式监测、高压氧疗法和无创脑刺激等多种方法,人工智能在治疗决策和个性化治疗中也展现出一定潜力。新兴的序贯组合策略和精准医疗方法有助于改善治疗效果,但存在对慢性期机制研究不足、技术整合困难等挑战。未来的创伤性脑损伤研究应关注个性化治疗策略、技术标准化、成本效益评估和合并症患者需求,采用多学科方法推进治疗,以改善患者预后。

https://orcid.org/0000-0002-8572-6470 (Yanmei Zhao); https://orcid.org/0000-0003-1111-0232 (Haojun Fan)

关键词: 人工智能, 生物标志物, 血脑屏障, 综合疗法, 给药, 外泌体, 聚焦超声, 高压氧疗法, 炎症, 纳米载体, 神经变性, 个性化医疗, 干细胞, 治疗性低温, 创伤性脑损伤

Abstract: Blood–brain barrier disruption and the neuroinflammatory response are significant pathological features that critically influence disease progression and treatment outcomes. This review systematically analyzes the current understanding of the bidirectional relationship between blood– brain barrier disruption and neuroinflammation in traumatic brain injury, along with emerging combination therapeutic strategies. Literature review indicates that blood–brain barrier disruption and neuroinflammatory responses are key pathological features following traumatic brain injury. In the acute phase after traumatic brain injury, the pathological characteristics include primary blood– brain barrier disruption and the activation of inflammatory cascades. In the subacute phase, the pathological features are characterized by repair mechanisms and inflammatory modulation. In the chronic phase, the pathological features show persistent low-grade inflammation and incomplete recovery of the blood–brain barrier. Various physiological changes, such as structural alterations of the blood–brain barrier, inflammatory cascades, and extracellular matrix remodeling, interact with each other and are influenced by genetic, age, sex, and environmental factors. The dynamic balance between blood–brain barrier permeability and neuroinflammation is regulated by hormones, particularly sex hormones and stress-related hormones. Additionally, the role of gastrointestinal hormones is receiving increasing attention. Current treatment strategies for traumatic brain injury include various methods such as conventional drug combinations, multimodality neuromonitoring, hyperbaric oxygen therapy, and non-invasive brain stimulation. Artificial intelligence also shows potential in treatment decision-making and personalized therapy. Emerging sequential combination strategies and precision medicine approaches can help improve treatment outcomes; however, challenges remain, such as inadequate research on the mechanisms of the chronic phase traumatic brain injury and difficulties with technology integration. Future research on traumatic brain injury should focus on personalized treatment strategies, the standardization of techniques, costeffectiveness evaluations, and addressing the needs of patients with comorbidities. A multidisciplinary approach should be used to enhance treatment and improve patient outcomes.

Key words: artificial intelligence, biomarkers, blood–brain barrier, combination therapy, drug delivery, exosomes, focused ultrasound, hyperbaric oxygen therapy, inflammation, nanocarriers, neurodegeneration, personalized medicine, stem cells, therapeutic hypothermia, traumatic brain injury