脑缺血与缺血预处理及缺血耐受

Cerebral ischemia, pretreatment of ischemia and ischemic tolerance

目的:通过查阅近年来有关脑缺血预处理的相关文献,探讨脑缺血预处理的形成机制。资料来源:应用计算机检索PubMed1986-01/2002-01期间与脑缺血预处理相关的文章,检索词“cerebralischemia,ischemicpreconditioning,ischemictolerance”,并限定文章语言种类为English,同时计算机检索维普中文期刊1999-06/2004-08期间的相关文章,限定文章语言种类为中文,检索词“脑缺血,缺血预处理,缺血耐受”。资料选择:按以上检索要求进行检索,然后对资料进行初审,选取关于脑缺血预处理相关的基础及临床研究文献。资料提炼:共收集到40篇相关文献,30篇符合纳入标准,其余的10篇因系重复研究而被筛除。资料综合:脑缺血预处理可减轻再次缺血后的白细胞黏附和游出,早期的星形胶质细胞反应,能量代谢的变化,氧自由基和抗氧化酶变化,神经营养因子的产生等。缺血预处理的不同形成机制有:腺苷、一氧化氮、自由基、热休克蛋白、即早基因等。结论:脑缺血耐受是一个多种机制参与的自我保护现象,对缺血耐受的研究为脑保护治疗提供了新的思路、线索和方法。但是在多种机制中何种物质起主要作用,各种物质间的相互作用,信号转导途径等尚未完全阐明。

OBJECTIVE:To study the forming mechanism of pretreatment of cerebral ischemia through searching the relevant articles about pretreatment of cerebral ischemia in recent years. DATA SOURCES:Using the key terms “cerebral ischemia,ischemic preconditioning, ischemic tolerance',we searched the PubMed database for the relevant articles published from January 1986 to January 2002 in English,Meanwhile, using the same key terms in Chinese, we searched the Weipu Chinese journals database from June 1999 to August 2004.STUDY SELECTION:Through the first trial,articles relevant to the pretreatment of cerebral ischemia of basic and clinical research were selected. DATA EXTRACTION:A total of 40 articles were collected,among which 30 met the inclusive criteria and the rest 10 articles were excluded because of duplicated research. DATA SYNTHESIS:Pretreatment of cerebral ischemia could relieve the emigration and sticky of leucocyte, early astrocyte reaction,changes of nergy metabolism,oxygenderived free radidicals, changes of antioxidase,neurotrophic factor. The different forming mechanisms of pretreatment of cerebral ischemia contained adenosine,nitric oxide,free radical,heat shock protein,immediately early genes,etc.CONCLUSION:Cerebral ischemic tolerance is a selfprotection phenomenon that many kinds of mechanisms participated in; the study on its main mechanism offers a new therapeutical way for preventing and treating the cerebrovascular disease.But which kind of substance plays a main role in such many mechanisms,the interaction among substances and the pathway of signal transduction are not clear.