蛛网膜下腔出血后早期脑损伤的研究进展

Recent research progress in early brain injury after subarachnoid hemorrhage

蛛网膜下腔出血(SAH)是由多种脑血管疾病引起的一种复杂的临床综合征,可对中枢神经系统产生灾难性打击,其高致残率、病死率显著影响了患者的神经认知功能恢复,加重家庭和社会经济负担。其中颅内动脉瘤破裂出血是SAH最常见的病因(85%)。近年来,多项研究表明早期脑损伤(EBI)是导致蛛网膜下腔出血预后不良的重要因素。脑表面或脑底部血管破裂后,血液进入蛛网膜下腔的血液引起机体强烈的神经炎症反应,表现为小胶质细胞活化,外周免疫细胞募集,微循环障碍,血脑屏障破坏和神经细胞凋亡。本研究总结了目前已知的有关EBI的病理生理机制,同时讨论了蛛网膜下腔出血后EBI的潜在治疗靶点。

Subarachnoid hemorrhage(SAH)is a complex clinical syndrome caused by a variety of cerebrovascular diseases.It can have a disastrous impact on the central nervous system.Its high disability rate and mortality significantly affect the recovery of neurocognitive function and aggravate the burden of family and social economy.Intracranial aneurysm rupture and hemorrhage was the most common cause of SAH(85%).In recent years,many studies have shown that early brain injury(EBI)is an important factor leading to poor prognosis of SAH.After the rupture of blood vessels on the surface or bottom of the brain,the blood entering the subarachnoid space causes a strong neuroinflammatory reaction,which is manifested in microglia activation,peripheral immune cell recruitment,microcirculation disturbance,blood-brain barrier destruction and nerve cell apoptosis.This study summarizes the known pathophysiological mechanisms of EBI,and discusses the potential therapeutic targets of EBI after SAH.