动脉瘤性蛛网膜下腔出血后早期脑损伤机制研究现状

Current research on the mechanisms of early brain injury after aneurysmal subarachnoid hemorrhage

蛛网膜下腔出血(SAH)是一种危及人类一生身体健康的中枢神经系统急症,其中最典型的是动脉瘤性蛛网膜下腔出血(aSAH),约占自发性SAH的85%,其预后常伴随高发病率和病死率,即便幸存,也会伴有永久性残疾、认知缺陷和精神健康等后遗症。随着近几年基础医学及神经影像技术飞速发展,虽然在aSAH的诊断和治疗及病理生理上研究有所突破,但目前影响aSAH预后机制还未有明确定义。大量研究证实,早期脑损伤(EBI)已经被广泛认为是影响aSAH患者致残和死亡的重要原因,而不是早期研究的脑血管痉挛。在aSAH发生后,EBI是一个十分复杂的病理过程,包括了颅内压增高、脑微血管功能障碍、血-脑屏障(BBB)破坏、神经细胞凋亡、自噬、氧化应激反应、线粒体功能障碍、神经炎症、皮层扩散性去极化等。本文对影响aSAH预后的EBI病理机制研究的新进展进行综述,旨在为临床治疗与预防提供理论基础。

Scubarachnoid hemorrhage(SAH)is a lifelong central nervous system emergency,the most typi cal of which is aneurysmal subarachnoid hemorrhage(aSAH),which accounts for approximately 85%of spontane ous SAH.The prognosis is often accompanied by high morbidity and mortality,and even if survived,there are se quelae of permanent disability,cognitive deficits and mental health problems.With the rapid development of ba sic medicine and neuroimaging technology in recent years,there have been breakthroughs in the diagnosis and treatment of aSAH and in the pathophysiology of the disease,but the mechanisms affecting the prognosis of aSAH are not yet clearly defined.A large number of studies have confirmed that early brain injury has been widely recog nised as an important cause of disability and death in aSAH patients rather than cerebral vasospasm,which was studied earlier.After the onset of aSAH,EBI is a complex pathological process that includes increased intracrani al pressure,cerebral microvascular dysfunction,disruption of the blood brain barrier(BBB),neuronal apopto sis,autophagy,oxidative stress,mitochondrial dysfunction,neuroinflammation,and cortical spreading depolariza tion.In this paper,we review new developments in the study of the pathological mechanisms of EBI that affect the prognosis of aSAH,with the aim of providing a theoretical basis for clinical treatment and prevention.