卒中后脑–心相互作用

Interactions between Brain and Heart after Stroke

神经心脏病学是一个新兴的专业领域,致力于研究和解决大脑和心脏之间的相互作用,其重点在于探究心脏损伤对大脑的影响以及脑损伤对心脏的影响。据统计,大多数卒中后死亡归因于神经系统损伤,而心血管并发症则是卒中后死亡的次要原因。临床和实验研究的累积证据表明脑损伤与心功能障碍之间存在因果关系。因此,我们需要确定心功能不全是由中风引发的,还是一个独立的并发症,或者说是中风的根本原因。中风引起的心脏损伤可能导致死亡或潜在的终身心脏问题,例如心力衰竭,也可能是轻度和可恢复的损伤,例如神经源性应激性心肌病和Takotsubo心肌病。卒中后脑损伤的位置和偏侧化在脑–心相互作用中发挥着重要作用;心脏并发症的临床生物标志物和表现;以及可能的机制,如下丘脑–垂体–肾上腺轴、儿茶酚胺激增、交感神经和副交感神经调节、肠道微生物组、免疫应答和全身炎症等,也是研究的焦点。本文综述了卒中后脑–心相互作用的重要内容。

Neurocardiology is an emerging specialty that studies and addresses the interactions between the brain and the heart, with a focus on exploring the effects of cardiac injury on the brain and the effects of neurological damage on the heart. Statistically, neurological damage stands as the leading cause of post-stroke mortality, while cardiovascular complications emerge as a significant secondary contributor. Cumulative evidence from clinical and experimental studies suggests a causal relationship between brain injury and cardiac dysfunction. Therefore, we need to determine whether cardiac dysfunction is caused by stroke, or whether it is an independent complication, or the underlying cause of stroke. Heart injury caused by stroke can lead to death or potentially lifelong heart problems, such as heart failure, or it can be milder and reversible conditions, such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The location and lateralization of post-stroke brain damage play important roles in brain-heart interactions, alongside clinical biomarkers and manifestations of cardiac complications, along with potential mechanisms such as the hypothalamic-pituitary-adrenal axis, catecholamine surge, regulation by the sympathetic and parasympathetic nervous systems, gut microbiota, immune response, and systemic inflammation. This review focuses on exploring the interactions between the brain and the heart following a stroke.