颅脑损伤后创伤后应激障碍的研究进展

创伤后应激障碍(PTSD)是临床上常见的应激后反应,多见于重大创伤后,具有发病率高、临床表现复杂、治疗难度大等特点,已成为世界范围内广泛关注的公共卫生问题。颅脑损伤是引起PTSD的重要因素,近年来针对颅脑损伤后PTSD展开了一系列研究。本文通过回顾近年来有关颅脑损伤后PTSD的基础与临床研究,对颅脑损伤与PTSD相关性的流行病学特征、发病机制、诊断与鉴别以及药物和心理治疗中的进展和面临的困难进行综述,以期为颅脑损伤后PTSD的深入研究提供理论依据和新思路。     

5-脂氧合酶（5-LOX）及代谢产物在异氟醚预处理脑保护作用中的研究进展

缺血性脑血管疾病（Ischemia Cerebral Vascular Disease,ICVD）可造成不同程度的神经功能障碍,以其高发病率、高致残率、高复发率、高死亡率严重威胁着人们的身体健康。而脑组织缺血后再灌注损伤即脑缺血再灌注损伤（ischemia-reperfusion injury）是脑缺血性疾病的最主要的损伤原因之一,因此阐明脑缺血再灌注损伤发生发展的病理生理机制、探寻有效的预防保护措施成为当今研究的重点问题。本文回顾、归纳脑缺血再灌注损伤的相关分子机制及异氟醚预处理对脑缺血再灌注损伤的保护作用,分析5-脂氧合酶及其代谢产物在脑缺血再灌注损伤中的作用及其与其他分子的相互关系,旨在探讨5-脂氧合酶及其代谢产物在异氟醚预处理保护脑缺血再灌注损伤中可能起到的作用。为脑缺血再灌注损伤的防治提供更多的理论依据。     

腺苷A2A受体在小鼠颅脑创伤与外周组织损伤模型中的作用差异

本文旨在探索腺苷A2A受体在颅脑创伤、皮肤创伤及放射损伤复合创伤中的作用差异.分别观察和检测野生型小鼠、A2A受体基因敲除小鼠以及给予A2A受体激动剂CGS21680治疗的小鼠在皮肤创伤、放射损伤复合创伤后的伤口愈合时间以及颅脑创伤后的神经功能缺损情况、伤侧皮层脑含水量、脑脊液中谷氨酸浓度.结果表明,CGS21680促进外周组织伤口愈合,却加重颅脑创伤模型的神经功能损害,这与其促进谷氨酸释放有关.相反,A2A受体基因敲除显著延迟小鼠皮肤创伤及放射损伤复合创伤模型的伤口愈合,而在颅脑创伤模型中通过抑制谷氨酸释放产生保护效应.本研究初步证实,A2A受体激活促进谷氨酸大量释放可能是其在中枢损伤与外周损伤产生作用差异的机理之一,这为将来临床应用A2A受体激动剂减轻外周损伤,而用A2A受体拈抗剂减轻颅脑损伤提供了一定的实验依据.     

高血糖加重脑缺血损伤机制的研究现状

脑缺血是引起人类死亡的一个重要原因,由于其发病的分子机制十分复杂,各种因子作用相互影响,且多数因子的作用同时存在损伤和保护两种机制,使得脑缺血的研究充满了困难。目前众多研究都证实高血糖对缺血脑组织有损害作用,并可能导致局部或广泛缺血后预后更差。本文依据近几年的实验,重点阐述了五种最新的高血糖加重脑缺血过程和预后损伤的机制假说,包括高血糖通过引起过量谷氨酸释放导致的Ca2^＋大量内流造成损伤、高血糖状态下造成氧化应激从而产生各种自由基对神经元造成损伤、炎症因子相关的损伤、高血糖相关的血液灌流的减少以及高血糖造成脑内酸中毒从而引起损伤。期望这些对机制的探讨能够上加深广大医药研究人员对高血糖加重脑缺血损伤的认识,帮助找到新的药物作用靶点和治疗手段,启发新的研究思路。     

Toll样受体在创伤后炎症反应中的作用

创伤后发生炎症反应以促进损伤恢复,反映了天然免疫的活化。Toll样受体家族(TLRs)不仅能识别病原体相关分子模式(PAMPs),近来发现其某些成员,尤其是TLR4对于无菌性损伤后释放的众多内源性分子即损伤相关分子模式(damage-associated molecular patterns,DAMPs)也有反应。通过基因突变或基因敲除动物证实,在局部损伤、失血性休克、股骨骨折等模型中,TLRs在局部炎症反应、远隔器官损害、全身炎症反应中也有重要作用。通过研究TLRs,对于深入理解创伤后局部及全身炎症反应发生、发展动态过程具有重要意义,有助于阐释创伤后并发症发生的机制,甚至可能寻找到调节创伤早期炎症反应的治疗靶点。     

NSE和NGF在颅脑损伤后血清中含量变化及临床意义

创伤性颅脑损伤后外周血清中神经元特异性烯醇化酶（NSE）和神经生长因子（NGF）含量呈动态变化,在颅脑损伤（尤其是重型颅脑损伤）早期即可出现表达增加,其中NSE含量与颅脑损伤程度呈正相关,而NGF在颅脑损伤后的神经修复、再生和神经元保护等机制中起重要作用,其在血清中含量变化的临床意义明显不同。两者在血清中含量变化对于颅脑损伤后病情、治疗及预后评估有重要的作用,是颅脑损伤后评估病情、进行治疗的重要指标,因此监测血清中NSE及NGF的变化,可以为更准确判断病情、评估预后,并为临床治疗提供依据。本文就其在颅脑损伤患者血清中的含量变化及临床意义作以简要综述。     

NSE 和NGF 在颅脑损伤后血清中含量变化及临床意义

创伤性颅脑损伤后外周血清中神经元特异性烯醇化酶(NSE)和神经生长因子(NGF)含量呈动态变化,在颅脑损伤(尤其是重型颅脑损伤)早期即可出现表达增加,其中NSE含量与颅脑损伤程度呈正相关,而NGF在颅脑损伤后的神经修复、再生和神经元保护等机制中起重要作用,其在血清中含量变化的临床意义明显不同。两者在血清中含量变化对于颅脑损伤后病情、治疗及预后评估有重要的作用,是颅脑损伤后评估病情、进行治疗的重要指标,因此监测血清中NSE及NGF的变化,可以为更准确判断病情、评估预后,并为临床治疗提供依据。本文就其在颅脑损伤患者血清中的含量变化及临床意义作以简要综述。     

何首乌提取物减轻大鼠脑缺血再灌注损伤和上调脑内UCP4蛋白水平

目的研究何首乌提取物对脑缺血再灌注损伤UCP4的影响,初步探讨其可能的作用机制。方法健康雄性SD大鼠采用线栓法复制局灶性脑缺血(MCAO)再灌注损伤模型,缺血2h后再灌注6h或24h,部分缺血再灌注模型大鼠分别灌胃不同浓度何首乌口服液。免疫组织化学染色和Western blot检测脑内UCP4表达,TTC染色检测脑梗死面积。结果在脑缺血再灌注6h后损伤,UCP4蛋白在海马内表达增高,再灌注24h后表达降低;何首乌提取物能浓度依赖性减少脑缺血再灌注损伤的脑梗死面积和上调UCP4表达。结论何首乌提取物能明显改善大鼠脑缺血再灌注损伤,其机制可能与脑内线粒体蛋白UCP4表达升高,保护神经元有关。     

缺血性脑血管疾病患者颈动脉彩超检测的应用价值

在动脉粥样硬化的情况下,颈总动脉至颈内外动脉分叉处容易形成粥样硬化斑块性狭窄及血栓,从而导致一过性脑缺血发作(TIA)或脑卒中。本文应用彩色多普勒超声通过对62例缺血性脑血管疾病患者颈动脉血管的检测,对颈动脉硬化斑块性质及血流受阻程度研究,以探讨缺血性脑血管疾病的早期的发现和预防治疗的措施。     

长链非编码RNA调节缺血性脑卒中损伤和修复的研究进展

长链非编码RNA(long noncoding RNA,lnc RNA)是一组在转录、转录后和表观遗传水平发挥作用的调控序列,其在中枢神经系统中特异性高表达,对中枢神经系统发育和疾病发展具有重要调控作用。缺血性脑卒中诱导脑内大量lnc RNA表达改变,提示lnc RNA与缺血性脑卒中复杂的病理过程有关,这将有利于全面认识缺血性脑卒中的病理机制及脑缺血损伤后的分子调控网络,并提供新的治疗方向。尽管有少数研究报道lnc RNA在缺血性心脏病中的作用,但目前对于其在缺血性脑卒中病理发展中的作用知之甚少。综述目前已知的lnc RNA在脑缺血再灌注损伤、细胞凋亡与抗凋亡及损伤后神经再生与修复中的作用,并提出了未来可能的lnc RNA在缺血性脑卒中损伤与修复中的研究方向。     

远端缺血后处理对脑缺血保护作用的研究进展

近20多年来人们对脑缺血损伤的保护研究很多,但真正能将脑缺血保护从基础研究应用到临床治疗的措施甚少。多数基础研究表明缺血预处理对大鼠脑缺血具有保护作用,然而由于脑缺血的不可预见性,研究者们将目标转向了缺血后处理。远端缺血后处理是指在非缺血器官交替实施短时间的缺血和再灌注后对缺血器官所产生的作用。由于脑组织本身对缺血的敏感,很难控制缺血后处理的程度,因此远端缺血后处理被应用到脑缺血的保护研究具有很强的临床应用价值,其机制可能与氧自由基、神经传导、蛋白质、内质网应激、Akt信号通路、线粒体途径、mitoKATP和阿片受体有关。本文主要就近几年远程缺血后处理对脑缺血保护的概念、实施方法、保护作用及分子机制做一综述。     

神经调节素对大鼠脑缺血再灌注损伤后炎症反应的抑制作用和机制研究

目的：研究神经调节素及基质金属蛋白酶-9对于小鼠大脑缺血再灌注损伤后炎症反应的抑制作用和机制。方法：选取100只成年雄性大鼠,随机分成对照和治疗组。采用线栓方法由颈内到颈外进行插线处理,造成大脑中动脉处于闭塞状态的再灌注动物模型。治疗组颈动脉进行注射少量NRG-1β干预性治疗,通过氯化三苯基四氮唑（TTC）检查脑梗塞范围,细胞凋亡采用原住脱氧核糖核苷酸末端转移酶介导缺口末端进行标记,采用免疫组织化学、免疫荧光双标记法及免疫印迹法观察脑组织基质金属蛋白酶-9（MMP-9）表达。结果：脑缺血再灌注损伤后,随时间延长及缺氧,对照组大鼠大脑皮质和纹状体区脑组织细胞凋亡,并且胶质细胞MMP-9蛋白表达逐渐增加。治疗组大鼠经注射NRG-1β干预性治疗后,缺血脑组织梗死范围及其细胞凋亡数量相对呈明显下降趋势。胶质细胞MMP-9表达呈降低趋势。结论：大鼠脑缺血再灌注损伤后体内NRG-1β抑制胶质细胞MMP-9的表达,控制缺血脑组织梗死的范围并抑制正常细胞的凋亡,发挥了重要的抗炎作用,可作为对于大脑缺血再灌注损伤的研究新靶点。     

Thioredoxin-1 attenuates post-ischemic neuronal apoptosis via reducing oxidative/nitrative stress

Recent studies show that Thioredoxin (Trx) possesses a neuronal protective effect and that Trx inactivation is closely related to cerebral ischemia injury. Peroxynitrite (ONOO⁻) formation may trigger oxidative/nitrative stress and represent a major cytotoxic effect in cerebral ischemia. The present study was conducted to validate whether treatment with recombinant human Trx-1 (rhTrx-1) would attenuate ONOO⁻ generation and oxidative/nitrative stress in focal transient cerebral ischemia. The results showed that intravenously administered rhTrx-1 (10 mg/kg) significantly improved neurological functions and reduced cerebral infarction and apoptotic cell death following cerebral ischemia. Neuronal ONOO⁻ formation was significantly attenuated after rhTrx-1 treatment. Moreover, rhTrx-1 resulted in a significant decrease in antioxidant capacity and p38 mitogen activated protein kinase (MAPK) activity in ischemic brain tissue. Furthermore, the suppression on ONOO⁻ formation by either rhTrx-1 or an ONOO⁻ scavenger uric acid reduced cerebral infarct size in mice subjected to cerebral ischemia. Peroxynitrite donor SIN-1 not only blocked the neuronal protection of rhTrx-1 but also markedly attenuated rhTrx-1-induced antioxidative/antinitrative effect. We concluded that rhTrx-1 exerts an antioxidative/antinitrative effect against cerebral ischemia injury by blocking ONOO⁻ and superoxide anion formation. These results provide the information that thioredoxin is much more likely to succeed as a therapeutic approach to diminish oxidative/nitrative stress-induced neuronal apoptotic cell death in the ischemic brain.     

Elevated N1-acetylspermidine levels in gerbil and rat brains after CNS injury

The polyamine system is very sensitive to different pathological states of the brain and is perturbed after CNS injury. The main modifications are significant increases in ornithine decarboxylase activity and an increase in tissue putrescine levels. Previously we have shown that the specific polyamine oxidase (PAO) inhibitor N1,N4-bis(2,3-butadienyl)-1,4-butanediamine (MDL 72527) reduced the tissue putrescine levels, edema, and infarct volume after transient focal cerebral ischemia in spontaneously hypertensive rats and traumatic brain injury of Sprague-Dawley rats. In the present study, N1-acetyl-spermidine accumulation was greater in injured brain regions compared with sham or contralateral regions following inhibition of PAO by MDL 72527. This indicates spermidine/spermine-N1-acetyltransferase (SSAT) activation after CNS injury. The observed increase in N1-acetylspermidine levels at 1 day after CNS trauma paralleled the decrease in putrescine levels after treatment with MDL 72527. This suggests that the increased putrescine formation at 1 day after CNS injury is mediated by the SSAT/PAO pathway, consistent with increased SSAT mRNA after transient ischemia.     

白藜芦醇对大鼠局灶性脑缺血再灌注的治疗作用

目的:观察白藜芦醇对大鼠局灶性脑缺血再灌注损伤的治疗作用及可能的机制。方法:将SD大鼠随机分为2组:对照组(n=16),白藜芦醇组(n=16)。对照组再灌注即刻腹腔给予0.5 ml生理盐水,白藜芦醇组再灌注即刻腹腔给予20 mg/kg白藜芦醇。再灌注22小时后,进行神经功能学评分、脑梗死容积测定,用分光光度仪测定脑组织溶浆中SOD、MDA和MPO的含量。结果:再灌注22小时后,白藜芦醇治疗组可以改善大鼠神经功能学评分和降低脑梗死面积(P<0.05),同时可以增加脑组织溶浆中SOD的活性,降低MDA和MPO的含量。结论:白藜芦醇通过减轻白细胞的浸润、提高自由基的清除率对大鼠局灶性脑缺血再灌注损伤发挥治疗作用。     

Perspectives on Neonatal Hypoxia/Ischemia-Induced Edema Formation

Neonatal hypoxia/ischemia (HI) is the most common cause of developmental neurological, cognitive and behavioral deficits in children, with hyperoxia (HHI) treatment being a clinical therapy for newborn resuscitation. Although cerebral edema is a common outcome after HI, the mechanisms leading to excessive fluid accumulation in the brain are poorly understood. Given the rigid nature of the bone-encased brain matter, knowledge of edema formation in the brain as a consequence of any injury, as well as the importance of water clearance mechanisms and water and ion homeostasis is important to our understanding of its detrimental effects. Knowledge of the pathological process underlying the appearance of dysfunctional outcomes after development of cerebral edema after neonatal HI in the developing brain and the molecular events triggered will allow a rational assessment of HHI therapy for neonatal HI and determine whether this treatment is beneficial or harmful to the developing infant.     

Effects of Thrombin on the Neurovascular Unit in Cerebral Ischemia

Cerebral ischemia is a cerebrovascular disease with high morbidity and mortality that poses a significant burden on society and the economy. About 60% of cerebral ischemia is caused by thrombus, and the formation of thrombus proceeds from insoluble fibrin, following its transformation from liquid fibrinogen. In thrombus-induced ischemia, increased permeability of the blood–brain barrier (BBB), followed by the extravasation of blood components into the brain results in an altered brain microenvironment. Changes in the brain microenvironment affect brain function and the neurovascular unit (NVU), the working unit of the brain. Recent studies have reported that coagulation factors interact with the NVU and its components, but the specific function of this interaction is highly speculative and warrants further investigations. In this article, we reviewed the role of coagulation factors in cerebral ischemia and the role of coagulation factors in thrombosis. Additionally, the influence of thrombin on the NVU is introduced, as well as in the function of NVU, which may help to explore part of brain injury mechanism during ischemia. Lastly, we propose some novel therapeutic approaches on ischemic stroke by reducing the risk of coagulation.

     

Prevention and repair of cerebral ischemia-reperfusion injury by Chinese herbal medicine, Shengmai San, in rats

The protective activity of Shengmai San, a traditional Chinese herbal medicine, was studied in cerebral ischemia-reperfusion injury in rats. Shengmai San consists of three herbal components, Panax Ginseng, Ophiopogon Japonicus and Schisandra Chinensis and is routinely being used for treating coronary heart disease.

When Shengmai San was injected directly into rat duodenum 2 h before cerebral ischemia by bilateral carotid artery occlusion, thiobarbituric acid reactive substance (TBARS) formation during reperfusion following ischemia was almost completely suppressed in the brain. The loss of glutathione perioxidase activity after the ischemia-reperfusion was also effectively prevented by the Shengmai San pre-administration whereas the activity was considerably decreased in the damaged brain.

It was found that Shengmai San also effectively suppressed the TBARS formation even when it was administered after 45 min reperfusion following ischemia, indicating that Shengmai San improves the oxidative damage already established in the brain. Likewise, the decrease of glutathione peroxidase activity was minimized in the damaged brain by the post-administration of Shengmai San.

On the other hand, none of the Shengmai San components were active in protecting the ischemia-reperfusion brain damage when they were independently administered.

These experiments suggest the potential of Shengmai San in both preventive and therapeutic usages for cerebral ischemia-reperfusion injury.     

多胺及其代谢产物对脑缺血的影响与治疗

多胺(Polyamines)是直链多价阳离子碱性胺,包括腐胺(putrescine,PUT),精胺(spermine,SPM),精脒(spermidine,SPD)等。广泛存在于各种组织细胞内,是一种代谢调控物质,在细胞的增殖分化中起着重要作用。脑梗死是成人致残、致死的最常见疾病之一。研究表明,脑缺血后,多胺及其代谢产物增加,能引起梗死面积的扩大及缺血半暗带神经细胞的坏死。其潜在机制尚不明确,可能与缺血后多胺代谢产生腐胺,3-氨基丙醛(3-amidopropanal 3-AP),过氧化氢及丙烯醛等的活性物质有关,它们参与开放钙离子通道,破坏血脑屏障,形成血管源性脑水肿及缺血再灌注性神经性损伤等病理过程。而抑制多胺代谢可有效地缓解缺血后多胺及其代谢产物增加引起的神经损伤。本文就多胺及代谢产物对脑缺血的神经毒性作用及药物抑制多胺代谢治疗脑梗死做一综述。     

Post-ischemic transcriptional and translational responses of EC-SOD in mouse brain and serum

Extracellular superoxide dismutase (EC-SOD) is neuroprotective, but its role in cerebral ischemia remains to be determined. We herein describe the topographical localization and quantitative changes in EC-SOD and its mRNA expression following cerebral ischemia in mice. Mice were subjected to transient forebrain ischemia and varied intervals of reperfusion. The measurements of EC-SOD using ELISA showed increased brain EC-SOD after 24 h of reperfusion and an increase in EC-SOD brain/serum ratio after 3 h. The immunohistochemical examination in normal mice showed strong EC-SOD immunoreactivity in the choroid plexus, pia mater, and ventral tuberal area of the hypothalamus. EC-SOD immunoreactivity in cortical and striatal capillary wall was conspicuous after 3 h. EC-SOD immunoreactivity was also noted in cortical neurons after 24 h. Northern blot analysis showed an increased EC-SOD mRNA expression in the brain after 24 h. An in situ hybridization study in normal mice demonstrated the mRNA expression of EC-SOD in choroid plexus and neurons through the brain especially in the cortex or ventral tuberal area of the hypothalamus, but demonstrated no mRNA expression of EC-SOD in the capillary wall. These findings suggest that EC-SOD accumulates on endothelial cells in response to this injury by an unknown mechanism, while cortical neurons produce EC-SOD themselves after cerebral ischemia with reperfusion.