目的:为了系统地研究血液中先前检查过的生物标志物,尿液,脑脊液,泪液,和丛集性头痛患者的唾液。
背景:丛集性头痛是一种在诊断和治疗方面具有广泛临床挑战的疾病。鉴定具有诊断意义或作为潜在治疗靶标的生物标志物是非常有必要的。
方法:我们进行了系统综述,包括同行评审的研究全文,这些研究测量了血液中的生化化合物,尿液,脑脊液,泪液,或在实施以英语编写的国际头痛疾病分类(1988)后诊断为丛集性头痛的患者的唾液,丹麦语,瑞典语,或者挪威人.参与需要至少五名参与者。搜索是在PubMed和EMBASE中进行的,2022年9月,提取的数据由两名作者筛选。遵循系统审查的首选报告项目和报告系统审查的荟萃分析指南。在病例对照研究中,使用纽卡斯尔-渥太华量表评估偏倚风险。
结果:我们纳入了40项研究,涉及832例丛集性头痛患者和872例对照,评估80个潜在的生物标志物。病例对照研究的偏倚风险中位数为6(范围:3-8),40项研究中有20项(50%)质量一般或良好。大多数研究被确定在三组中:下丘脑调节激素,炎症标志物,和神经肽。在下丘脑激素中,皮质醇是最常见的研究(N=7),在大多数研究中,在丛集性头痛中皮质醇升高。最常检查的炎症标志物是白细胞介素1(N=3),但是调查结果是不同的。降钙素基因相关肽是研究最多的神经肽(N=9),所有研究都发现发作期间水平升高。
结论:丛集性头痛的生物标志物研究结果不一致,且广泛无特异性,这解释了为什么以前的研究都没有成功确定丛集性头痛的独特生物标志物,而是有助于证实潜在的病理生理机制。一些被检查的生物标志物可以作为疾病活动的标志物,但不适合与对照和其他头痛明确区分。
OBJECTIVE: To systematically investigate previously examined biomarkers in blood, urine, cerebrospinal fluid, tear fluid, and saliva of patients with cluster headache.
BACKGROUND: Cluster headache is a condition with extensive clinical challenges in terms of diagnosis and treatment. Identification of a biomarker with diagnostic implications or as a potential treatment target is highly warranted.
METHODS: We conducted a systematic
review including peer reviewed full text of studies that measured biochemical compounds in either blood, urine, cerebrospinal fluid, tear fluid, or saliva of patients with cluster headache diagnosed after the implementation of the International Classification of Headache Disorders (1988) written in English, Danish, Swedish, or Norwegian. Inclusion required a minimum of five participants. The search was conducted in PubMed and EMBASE, in September 2022, and extracted data were screened by two authors. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews were followed. The Newcastle-Ottawa Scale was used to assess the risk of bias in case-controlled studies.
RESULTS: We included 40 studies involving 832 patients with cluster headache and 872 controls, evaluating 80 potential biomarkers. The risk of bias for case-controlled studies was a median of 6 (range: 3-8) and 20 studies out of 40 (50%) were of fair or good quality. Most studies were identified within three groups: hypothalamic-regulated hormones, inflammatory markers, and
neuropeptides. Among the hypothalamic hormones, cortisol was the most frequently investigated (N = 7) and was elevated in cluster headache in most of the studies. The most frequently examined inflammatory marker was interleukin 1 (N = 3), but findings were divergent. Calcitonin gene-related peptide was the most investigated neuropeptide (N = 9) and all studies found increased levels during attacks.
CONCLUSIONS: Biomarker findings have been inconsistent and widely non-specific for cluster headache, which explains why none of the previous studies succeeded in identifying a unique biomarker for cluster headache, but instead contributed to substantiating the underlying pathophysiologic mechanisms. Several of the examined biomarkers could hold promise as markers for disease activity but are unfit for a clear distinction from both controls and other headaches.