JAMA发表震惊体育圈研究:橄榄球运动员多有脑部损伤疾病
2017/07/27
7月25日的JAMA上发表了震惊体育圈的研究报告:大部分捐献大脑用作研究的橄榄球运动员在他们活着的时候遭受退行性脑部疾病。表明在美式橄榄球比赛中,大脑的重复损伤与这种疾病有关。样本并不一定代表一般的橄榄球运动员人群。但结果仍然令人担忧。


根据有史以来研究过的最大球员样本,大部分捐献大脑用作研究的橄榄球运动员在他们活着的时候遭受退行性脑部疾病。研究人员说,这一发现提供了更多的证据,表明在美式橄榄球比赛中,大脑的重复损伤与这种疾病有关。相关研究文章发表在7月25日的JAMA上。

已故前橄榄球运动员慢性创伤性脑病比例惊人

研究人员依靠对球员的尸检来明确诊断,采访家庭成员和朋友的球员了解他们所经历的症状。在202名已故前橄榄球运动员中,有177名被诊断患有慢性创伤性脑病,这可能导致许多情绪和行为问题,比如思考和推理方面的问题。在参与全美橄榄球联赛的111人中,110人(高达99%)患有这种疾病。14名高中生运动员中也有三人有脑部疾病的迹象,53名大学运动员中有48名。

尽管有许多球员在退役之后都被诊断出脑部运动创伤,一直以来,美式橄榄球联盟方面坚称,没有足够的学术研究能够完全证明两者之间有直接联系。直到2016年波士顿大学对退役橄榄球运动员进行了思考和记忆力测试和脑部扫描,发现他们中的43%脑部有损伤。美式橄榄球联盟不得不承认橄榄球与脑损伤有直接联系。今年JAMA上发表的这篇文章是以病理切片的确诊方式坐实了橄榄球与脑损伤的关系。

唯一的诊断方法尸检显示tau蛋白聚集

慢性创伤性脑病,或称CTE,表明了在运动员和其他人已经在头部有重复损伤,如脑震荡。诊断这种疾病的唯一方法是尸检。在这种情况下,一种叫tau的蛋白质在神经细胞和其他脑细胞中形成团块。虽然tau蛋白也聚集在其它如阿尔茨海默氏症的脑部疾病;CTE的话,tau蛋白质聚集在小血管周围的脑细胞。


病例切片显示tau蛋白(深红色)在大脑中分布越来越广:上图是一个大学橄榄球运动员的大脑,有轻度的慢性外伤性脑病;下图是全美橄榄球联赛的运动员的大脑,慢性外伤性脑病比较严重。

2008起,研究小组成立了一个大脑银行,用来研究运动或服兵役引起的头部撞击的影响。波士顿大学医学院的行为神经学家Jesse Mez和他的同事鉴定出球员有轻微或严重的CTE,程度取决于tau蛋白团块在球员的大脑中的分布状况。Mez说疾病的严重程度似乎与参与橄榄球运动的年数相吻合。参与全美橄榄球联赛的球员里,110例确诊病例中有95例病情严重。所有三名高中生的病例都是轻微的,而超过一半的大学球员的病例是严重的。

无论严重程度症状类似

然而,无论是在大脑中观察到的严重程度如何,球员活着时的症状都是相似的。行为和情绪问题:如冲动,焦虑和抑郁,在疾病的严重和轻微的病例中都有普遍报道。认知症状,包括记忆丧失,对这两个群体也是典型的。Mez说一个主要的区别,相对CTE较轻度组,痴呆在严重的病例中更常见。

至于为什么球员的报告都经历了类似的症状,无论轻重,Mez说:“问题是,是否有其他的情况发生,如炎症。或者我们在大脑中还有没仔细观察的区域?”

更深入的研究对于全美橄榄球联赛至关重要

这并不意味着所有的橄榄球运动员都会经历慢性创伤性脑病。许多为研究而捐献大脑的家庭之所以这样做,是因为他们所爱的人有明显的症状。所以样本并不一定代表一般的橄榄球运动员人群。但研究人员说,结果仍然令人担忧。

为这篇文章撰写编辑意见(Editorial)的,加州大学三藩分校的神经学家Gil Rabinovici说:“事实上,慢性创伤性脑病是如此普遍,增加了我们对橄榄球比赛安全性的考虑以及在以后的生活中出现神经症状的风险问题的顾虑。即使这项研究不能回答疾病的频率是多少和谁是有风险的,对任何级别都比赛都是挥之不去的阴影。”

检测患者的疾病了解常见的CTE,对于美式橄榄球联盟是至关重要的,别说参加人达百万的大学、高中和青少年橄榄球。Rabinovici说:“同时在各级接触性运动中,我们需要着重预防脑震荡和其它头部碰撞。”

参考资料

Clinicopathological evaluation of chronictraumatic encephalopathy in players of American football

Most football players who donated their brains to science had traumatic injury

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  • Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football

    Importance Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE). Objective To determine the neuropathological and clinical features of deceased football players with CTE. Design, Setting, and Participants Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history. Exposures Participation in American football at any level of play. Main Outcomes and Measures Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia. Results Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre–high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia. Conclusions and Relevance In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.

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