腦水腫的發(fā)病機(jī)理及藥物治療

1、腦水腫的發(fā)病機(jī)理及藥物治療,醫(yī)院及講者信息,腦水腫,腦實(shí)質(zhì)聚集過量液體,腦水腫分類,血管源性腦水腫血腦屏障受損所致，大量液體和血管內(nèi)蛋白質(zhì)積聚于腦白質(zhì)細(xì)胞間隙常見于腦創(chuàng)傷、腦出血、腦缺血的第二階段,腦水腫分類,細(xì)胞毒性腦水腫ATP失功、細(xì)胞內(nèi)外Na+轉(zhuǎn)運(yùn)失衡所致水腫液分布于腦細(xì)胞內(nèi)，細(xì)胞間隙不但不擴(kuò)大，反而縮小常見于腦缺血和肝衰,腦水腫動(dòng)物實(shí)驗(yàn)?zāi)Ｐ?凍傷模型液壓沖擊傷模型腦出血模型水中毒模型肝損模型,The Cold

2、Injury Model,Cold injury is performed byinflicting freeze stimulation on the hemisphere of the skull of the animal,After cold injury, BBB disruption is indicated by evaluating extravasation of Evans blue dye,凍傷模型主要用于血管

3、源性腦水腫的試驗(yàn)?zāi)Ｐ蛢鰝苯悠茐难芗?xì)胞，導(dǎo)致不可逆的血腦屏障損傷特點(diǎn)：試驗(yàn)的可重復(fù)性及受傷面積的準(zhǔn)確性,The Fluid Percussion Injury (FPI) Model,Fluid percussion injury is performed by an injury to the intact dura after craniectomy by impacts of rapidly pushed fluid (B1

4、,B2). As well as cold injury, the extravasation of Evans blue dye is observed (B3).,液壓沖擊傷模型模擬腦創(chuàng)傷引發(fā)的腦水腫可誘導(dǎo)各種降解酶如MMP-9的激活，導(dǎo)致血管基底膜的降解可觀察到炎性介質(zhì)的增加及巨噬細(xì)胞的浸潤；,The Cerebral Hemorrhage Model,通過腦實(shí)質(zhì)內(nèi)注射膠原蛋白酶破壞血管基底膜或者注射自體血制備腦出血模型（

5、ICH model）常見的蛛網(wǎng)膜下腔出血模型（SAH model）包括：單側(cè)出血、雙側(cè)出血、血管內(nèi)穿刺模型可同時(shí)觀察到血管源性腦水腫及細(xì)胞毒性腦水腫,The Water Intoxication Model,induces a relative decrease of extracellular Na+ concentration， best reflects simulation of hyponatremiaproduced

6、by intraperitoneal loading of excessive distilled water corresponding to 10%–40% of the body weight of experimental animalsadopted as a model of cytotoxic edema.,The Liver Failure Model,急性或慢性肝細(xì)胞失功引發(fā)的肝衰會(huì)誘導(dǎo)肝性腦病，造成中樞神經(jīng)組織嚴(yán)重

7、失功。急、慢性肝衰導(dǎo)致的腦水腫發(fā)病機(jī)制不同急性肝衰，ICP上升；慢性肝衰很少觀察到ICP上升肝衰模型產(chǎn)生的腦水腫為細(xì)胞毒性腦水腫星形細(xì)胞腫脹血腦屏障未見損害一般采用硫代乙酰胺誘導(dǎo)肝細(xì)胞損傷氨基半乳糖誘導(dǎo)急性肝衰膽管結(jié)扎或門腔靜脈吻合術(shù)誘導(dǎo)慢性肝衰,評(píng)估腦水腫方法,干濕稱重法重量法MRI檢測法,Wet-Dry Weight Method,a common and simple methodinvasive and n

8、ot performed in patientsbased on the weight measurement of brain tissue before and after complete dehydrationWater content (%) = 100× (wet weight ? dry weight) /wet weightWater content = (wet weight ? dry weight)

9、/dry weight Tissue swelling (%) = 100× (final wet weight ? initial wet weight) /initial wet weightwet weight：The weight before dehydrationdry weight：the weight after dehydration,The Gravimetric Method,The gravime

10、tric technique is based on calculating the percentage of water from measuring the density of the tissue in experimental animalsThis method is also invasive and not performed in patientsAdvantages:higher sensitivityus

11、e of smaller pieces of tissue,Magnetic Resonance Imaging (MRI),a noninvasive method，used for evaluating brain edema in patients and experimental animalsTwo Index:apparent diffusion coefficient（ADC）reduced ADC values c

12、orrelate with cytotoxic edemaT2 imagingthe increased T2 values reflect the development of vasogenic edema,腦水腫關(guān)鍵因子及治療,VEGF、MMPs、AQPs、NKCC1、ETB-R、GR,腦水腫生成關(guān)鍵因子,,,,抗水腫治療藥物,麥通納作用機(jī)制,作用與GCR/NF?κB 信號(hào)通路，抗炎作用上調(diào)GC受體表達(dá)，抑制 NF?κB的活

13、化1,2抑制TNF-α,IL-1β等炎癥因子的產(chǎn)生3封閉毛細(xì)血管，減少毛細(xì)血管壁上小孔的數(shù)量和直徑4維持正常血管通透性 抑制局部炎癥細(xì)胞滲出提高SOD活性，清除氧自由基5,1，EXPERIMENTAL AND THERAPEUTIC MEDICINE 6: 419-422, 20132，Mol Pharmacol. 2010 May;77(5):818-273，J Zhejiang Univ Sci B. 2005 Jan

14、;6(1):28-324，Arzneimittelforschung. 1970 May;20(5):699-7035，Yao Xue Xue Bao. 2004 Jun;39(6):419-23.,麥通納顯著提高糖皮質(zhì)激素受體的表達(dá),脂多糖(LPS)誘導(dǎo)的炎癥小鼠模型中，GR蛋白水平表達(dá)顯著下降（p0.05) ；麥通納顯著提高GR蛋白的表達(dá)，不僅在麥通納組，且在脂多糖+麥通納組, GR蛋白水平顯著高于對(duì)照組（p<0.01)

15、a,對(duì)照組；b,麥通納鈉組（3.6mg/kg);c,LPS組；d,地塞米松（4.0mg/kg） +LPS組；f,麥通納（1.8mg/kg)+LPS組;g,麥通納（3.6mg/kg) )+LPS組,N. Jiang et al. / Phytomedicine 18 (2011) 1276– 1284,麥通納協(xié)同激素抗炎消腫,低劑量可的松、麥通納聯(lián)合給藥6h，水腫顯著減輕,,,N. Jiang et al. / Phytomedicin