短暂性脑缺血后脑梗死与纤维蛋白原水平的相关性研究

目的 探讨短暂性脑缺血发作(TIA)后患者发生脑梗死与血浆纤维蛋白原水平的相关性.方法 回顾性分析我院128例TIA患者的病历资料,比较脑梗死患者与TIA稳定患者的临床资料和血常规、血糖、血脂、肌酐和纤维蛋白原等指标,并进行多因素Logistic回归分析.结果 128例患者中,20例(15.6％)患者发生脑梗死,脑梗死患者与稳定患者的一般资料和血常规、血糖、血脂、肌酐等资料比较差异无统计学意义(P＞0.05);脑干梗死患者的血浆纤维蛋白原水平显著高于稳定患者(P＜0.05);多因素Logistic回归分析结果显示,纤维蛋白原与TIA患者脑梗死的发生具有显著相关性(OR＝ 0.625,P＜0.05).结论 纤维蛋白原是TIA患者发展为脑梗死的独立危险因素,其水平高低可以作为短暂性脑缺血患者预后的辅助判断指标.     

1-hydroxyPGE reduces infarction volume in mouse transient cerebral ischemia

Differential neurological outcomes due to prostaglandin E2 activating G-protein-coupled prostaglandin E (EP) receptors have been observed. Here, we investigated the action of the EP4/EP3 agonist 1-hydroxyPGE1 (1-OHPGE1) in modulating transient ischemic brain damage. C57BL/6 mice were pretreated 50 min before transient occlusion of the middle cerebral artery with an intraventricular injection of 1-OHPGE1 (0.1, 0.2, 2.0 nmol/0.2 microL). Brain damage 4 days after reperfusion, as estimated by infarct volume, was significantly reduced by more than 19% with 1-OHPGE1 in the two higher-dose groups (P < 0.05). To further address whether protection also was extended to neurons, primary mouse cultured neuronal cells were exposed to N-methyl-D-aspartate. Co-treatment with 1-OHPGE1 resulted in significant neuroprotection (P < 0.05). To better understand potential mechanisms of action and to test whether changes in cyclic adenosine monophosphate (cAMP) levels and downstream signaling would be neuroprotective, we measured cAMP levels in primary neuronal cells. Brief exposure to 1-OHPGE1 increased cAMP levels more than twofold and increased the phosphorylation of extracellular-regulated kinases at positions Thr-202/Tyr-204. In a separate cohort of animals, 1-OHPGE1 at all doses tested produced no significant effect on the physiological parameters of core body temperature, mean arterial pressure and relative cerebral blood flow observed following drug treatment. Together, these results suggest that modulation of PGE2 receptors that increase cAMP levels and activate extracellular-regulated kinases 1/2 caused by treatment with 1-OHPGE1 can be protective against neuronal injury induced by focal ischemia.     

对短暂性脑缺血发作及其和脑梗死关系的重新认识

近年来，由于影像学技术的发展和临床广泛的应用，越来越多的证据使人们对短暂性脑缺血发作(TIA)及其和脑梗死有了新的认识，现结合文献介绍如下。     

短暂脑缺血发作特点与脑梗死的关系研究

目的:探讨短暂脑缺血发作(TIA)发作持续时间、发作次数及临床特征与脑梗死的关系。方法:对173例TIA患者临床资料进行回顾性分析,记录其发作持续时间、发作次数及临床特征。发作后均在24小时内行头颅MRI或CT检查,部分于发作48小时后复查,记录影像学异常(责任病灶)的例数。结果:TIA发作≤30分钟、>30分钟患者发生脑梗死比例分别为16/112、22/61,组间比较差异具有显著意义(P<0.01);TIA发作≤3次、>3次TIA患者发生脑梗死比例分别为19/129、19/44,组间比较差异具有显著意义(P<0.01);既往有、无卒中病史者发生脑梗死比例分别为15/43、23/130,组间比较差异具有显著意义(P<0.05);既往有、无高血压病史者发生脑梗死比例为28/102、10/71,组间比较差异具有显著意义(P<0.05);表现为偏肢无力和(或)麻木、非偏肢无力麻木者发生脑梗死的比例分别为33/82、5/91,组间比较差异具有显著意义(P<0.01)。结论:局灶神经功能障碍持续时间>30分钟、发作次数>3次、既往有卒中、高血压病史及表现为偏肢无力和(或)麻木的TIA患者发生脑梗死的比率明显增高。     

7—nitro—indazole减小大鼠暂时性局灶性脑梗塞灶范围

目的探讨神经元型一氧化氮合酶（ｎＮＯＳ）在暂时性局灶性脑缺血中的作用。方法用栓线法建立了大脑中动脉阻塞（ＭＣＡＯ）模型的大鼠上，观察特异性ｎＮＯＳ抑制剂７－ｎｉｔｒｏ－ｉｎｄａｚｏｌｅ（７－ＮＩ）对大鼠缺血３ｈ、再灌注３ｈ脑梗塞灶范围的影响。结果７－ＮＩ（２５ｍｇ／ｋｇ）可减小大鼠脑梗塞灶范围，且主要减小大脑皮质梗塞灶，其作用可被Ｌ－精氨酸（３００ｍｇ／ｋｇ）逆转，Ｄ－精氨酸（３００ｍｇ／ｋｇ）则否。结论ｎＮＯＳ产生的ＮＯ在暂时性局灶性脑缺血中起损害作用     

Effects of tetrahydrobiopterin on cerebral infarction after transient focal ischemia in rats

Abstract

Objectives: The present study investigated the effects of tetrahydrobiopterin (BH4) on cerebral infarction after transient focal ischemia in rats.

Methods: Focal ischemia (1·5 hours) was created in male Sprague-Dawley rats (250-280 g) by middle cerebral artery occlusion. Some rats were treated with 20 mg/kg tetrahydrobiopterin by intraperitoneal injection 30 minutes before reperfusion. At 2, 6, and 12 hours of reperfusion, the brains were harvested for the nitric oxide synthase (NOS) activity and nitric oxide (NO) level assays. At 12 hours of reperfusion, the brains were harvested for infarct size measurement.

Results: NOS activity and NO level were all augmented after reperfusion. BH4 treatment significantly further increased NOS activity and NO level. Cerebral infarct size was significantly bigger in BH4 treatment group compared to that in no treatment group.

Conclusions: The data indicate that BH4 enhances cerebral infarction after transient focal ischemia in rats, through NOS and NO pathway.     

Evolution of brain infarction after transient focal cerebral ischemia in mice.

The evolution of brain infarction after transient focal cerebral ischemia was studied in mice using multiparametric imaging techniques. One-hour focal cerebral ischemia was induced by occluding the middle cerebral artery using the intraluminal filament technique. Cerebral protein synthesis (CPS) and the regional tissue content of adenosine triphosphate (ATP) were measured after recirculation times from 0 hours to 3 days. The observed changes were correlated with the expression of the mRNAs of hsp-70, c-fos, and junB, as well as the distribution of DNA double-strand breaks, visualized by TUNEL. At the end of 1 hour of ischemia, protein synthesis was suppressed in a larger tissue volume than ATP in accordance with the biochemical differentiation between core and penumbra. Hsp70 mRNA was selectively expressed in the cortical penumbra, whereas c-fos and junB mRNAs were increased both in the lateral part of the penumbra and in the ipsilateral cingulate cortex with normal metabolism. During reperfusion after withdrawal of the intraluminal filament, suppression of CPS persisted except in the most peripheral parts of the middle cerebral artery territory, in which it recovered between 6 hours and 3 days. ATP, in contrast, returned to normal levels within 1 hour but secondarily deteriorated from 3 hours on until, between 1 and 3 days, the ATP-depleted area merged with that of suppressed protein synthesis leading to delayed brain infarction. Hsp70 mRNA, but not c-fos and junB, was strongly expressed during reperfusion, peaking at 3 hours after reperfusion. TUNEL-positive cells were detected from 3 hours on, mainly in areas with secondary ATP depletion. These results stress the importance of an early recovery of CPS for the prevention of ischemic injury and suggest that TUNEL is an unspecific response of delayed brain infarction.     

Immune cell infiltration in malignant middle cerebral artery infarction: comparison with transient cerebral ischemia

We tested whether significant leukocyte infiltration occurs in a mouse model of permanent cerebral ischemia. C57BL6/J male mice underwent either permanent (3 or 24 hours) or transient (1 or 2 hours+22- to 23-hour reperfusion) middle cerebral artery occlusion (MCAO). Using flow cytometry, we observed ∼15,000 leukocytes (CD45^+high cells) in the ischemic hemisphere as early as 3 hours after permanent MCAO (pMCAO), comprising ∼40% lymphoid cells and ∼60% myeloid cells. Neutrophils were the predominant cell type entering the brain, and were increased to ∼5,000 as early as 3 hours after pMCAO. Several cell types (monocytes, macrophages, B lymphocytes, CD8⁺ T lymphocytes, and natural killer cells) were also increased at 3 hours to levels sustained for 24 hours, whereas others (CD4⁺ T cells, natural killer T cells, and dendritic cells) were unchanged at 3 hours, but were increased by 24 hours after pMCAO. Immunohistochemical analysis revealed that leukocytes typically had entered and widely dispersed throughout the parenchyma of the infarct within 3 hours. Moreover, compared with pMCAO, there were ∼50% fewer infiltrating leukocytes at 24 hours after transient MCAO (tMCAO), independent of infarct size. Microglial cell numbers were bilaterally increased in both models. These findings indicate that a profound infiltration of inflammatory cells occurs in the brain early after focal ischemia, especially without reperfusion.     

低氧预处理对大鼠脑缺血再灌注后梗死体积和血脑屏障通透性的影响

目的　探讨低氧预处理对大鼠脑缺血再灌注损伤的保护作用。方法　将SD大鼠分为 3组 ,即假手术组、缺血再灌注组、缺氧预处理 +缺血再灌注组。连续吸入 8%O2 +92 %N2 3h作缺氧预处理 ,12h后再经插线左大脑中动脉栓塞 (MCAO)制作缺血再灌注模型 ,到相应时间点后观察缺氧预处理对MCAO大鼠的行为、脑含水量、血脑屏障通透性和脑梗死体积的影响。结果与缺血再灌注组相比 ,缺氧预处理组大鼠的行为明显改善 ,脑伊文思蓝 (EB)含量、脑含水量 (P <0 0 5 ) ,脑梗死体积缩小。结论　低氧预处理降低缺血再灌注脑组织血脑屏障通透性 ,抑制脑水肿 ,缩小梗死体积 ,对缺血再灌注损伤具有保护作用     

3-Aminobenzamide reduces brain infarction and neutrophil infiltration after transient focal cerebral ischemia in mice

Poly(ADP-ribose) polymerase (PARP) was shown to be detrimental in cerebral ischemia but the mechanisms whereby PARP is deleterious have yet to be determined. They may include a role in neutrophil infiltration known to aggravate ischemic damage. In this context, we investigated the effect of 3-aminobenzamide (3-AB), a PARP inhibitor, on brain damage and neutrophil infiltration after transient focal cerebral ischemia in mice. Ischemia was induced in male Swiss mice, anaesthetized with chloral hydrate (400 mg/kg, i.p.), by a 15-min-occlusion of the left middle cerebral artery using an intraluminal suture. Treatments with 3-AB were first administered intraperitoneally 15 min before reperfusion and endpoints measured at 24 h. Among the range of dosages studied (20-320 mg/kg), 40 mg/kg gave the maximal neuroprotection with a 30% decrease in the infarct volume and tended to improve the neurological score evaluated by a grip test. The same dosage was, however, devoid of effect when injection was delayed 2 or 6 h after reperfusion. Myeloperoxidase (MPO) activity used as an index of neutrophil infiltration showed that infiltration peaked 48 h after reperfusion in our model. At this time point, 3-AB (40 mg/kg given 15 min before reperfusion) markedly reduced the neutrophil infiltration, as evidenced by a 72%-decrease in MPO activity, and was still neuroprotective. Our results confirm that 3-AB reduces brain damage. Moreover, for the first time, a quantitative study shows that 3-AB decreases neutrophil infiltration elicited by cerebral ischemia.     

Tirilazad reduces cortical infarction after transient but not permanent focal cerebral ischemia in rats.

BACKGROUND AND PURPOSE: We examined the cytoprotective effect of the lipid peroxidation inhibitor tirilazad mesylate (U74006F) in rodent models of neocortical infarction induced by transient and permanent focal cerebral ischemia. METHODS: Wistar rats (experiment 1) and spontaneously hypertensive rats (experiment 2) were subjected to 2 hours of transient middle cerebral artery occlusion followed by 22 hours of reperfusion and pretreated with 10 mg/kg i.p. tirilazad, vehicle, or saline. Repeat doses were given at 4 and 10 hours after reperfusion. Spontaneously hypertensive rats were also subjected to permanent middle cerebral artery occlusion and either pretreated with tirilazad, vehicle, or saline intraperitoneally (experiment 3) or treated with either tirilazad or vehicle intravenously after ischemia (experiment 4). Cortical infarct volumes were measured 24 hours after the onset of either transient or permanent ischemia, and changes in core regional cerebral blood flow were monitored with laser Doppler flowmetry. RESULTS: Tirilazad reduced infarct volume after transient ischemia by 40% in Wistar rats (p = 0.08) (experiment 1) and 23% in spontaneously hypertensive rats (p less than 0.05) (experiment 2) but did not reduce infarction after permanent ischemia whether it was given intraperitoneally (experiment 3) or intravenously (experiment 4). Ischemic core blood flows were not affected during ischemia, nor were they affected during reperfusion after transient ischemia. CONCLUSIONS: Tirilazad reduces cortical infarction in transient but not permanent ischemia, an effect not related to improvement in regional cerebral blood flow. Tirilazad might prove to be useful as an adjuvant therapy after successful thrombolysis in acute stroke patients.     

Awareness intervention for Beijing neurologists regarding secondary prevention of cerebral infarction/transient ischemia——Cross-sectional investigation

BACKGROUND： Stroke prevention guidelines should be made available application to aid in uniformity, timing, preciseness, and acceptance of disease. OBJECTIVE： To investigate the awareness of neurologists in some Beijing secondary prevention of cerebral infarction/transient ischemia. DESIGN： Cross-sectional study. to neurologists for clinical hospitals of intervention in SETTING： Beijing Tiantan Hospital, Beijing Anzhen Hospital, General Hospital of Beijing Military Area, Command of Chinese PLA, Beijing Chuiyangliu Hospital, Beijing 6^th Hospital, Beijing Hepingli Hospital, and Beijing Daxing District Hospital. PARTICIPANTS： A total of 28 （associate） chief physicians, 58 attending physicians, and 54 resident physicians who engaged in clinical treatment of cerebrovascular diseases were selected from 8 hospitals in Beijing from March to April 2007. All physicians provided informed consent. METHODS： Self-made closed questionnaires were provided for data collection, consisting of 16 questions that were single choice or multiple choice. Specifically, questions 1-7 focused on awareness of blood pressure regulation in different patients and first choice of decompression drug; questions 8-12 focused on awareness of lipid regulation; and questions 13-16 focused on awareness of anti-blood platelet drugs applied in secondary prevention. The scores ranged from 0-100 points, and each question was worth 6.25 points. The scores positively correlated with the awareness rate. To test leveling real-time, the survey lasted for a maximum of 20 minutes. One questionnaire was independently finished by each subject in the survey. MAIN OUTCOME MEASURES： Awareness intervention among neurologists during secondary prevention of cerebral infarction/transient ischemia and questionnaire scores. RESULTS： 140 subjects were included in the final analysis. ① The awareness rate among neurologists for intervention during secondary prevention of cerebral infarction/transient ischemia ranged from 0.7-57.9%, the scores ranged betw     

吡拉西坦抗短暂性局灶性脑缺血作用观察

目的 观察吡拉西坦的抗局灶性脑缺血作用。方法采用动脉腔内插线大鼠局灶性脑缺血模型及激光多普勒血流计测定半暗带脑血流、湿重-干重法测定缺血半球水含量、3％伊文氏蓝染色结合图像分析测定血脑屏障(BBB)的破坏、HE染色结合图像分析测定缺血后21h的梗死体积。结果100mg／kg体重吡拉西坦对半暗带脑血流无明显影响，200mg／kg体重吡拉西坦可明显升高再灌注期间半暗带脑血流；100mg／kg和200mg/kg体重的吡拉西坦均可明显降低局灶性脑缺血后缺血半球的水含量及BBB的损伤，缩小梗死体积。结论吡拉西坦具有明确的抗局灶性脑缺血作用，它可改善半暗带脑血流、减轻脑组织水肿和BBB的损伤、缩小梗死体积。     

Gene therapy for cerebral infarction (cerebral ischemia)]

The treatment strategies of cerebral infarction have been studied in order to prevent neuronal cell death. Gene therapy is one of the most promising therapy and has several advantage over classical drug therapies. There has been a problem that drug proteins are unable or difficult to pass through blood brain barrier. In gene therapy, however, drug proteins are expressed in the brain with transgene transfer technique. Ischemic neural death proceeds with a complex series of pathophysiological events in the neurons. But molecular mechanism of ischemic neuronal cell death gradually understood. It has been known that a number of genes can be potent candidates for treatment factors of cerebral infarction. Actually, many investigators have been studied treatment strategies of cerebral infarction using a variety of neurotrophic factors such as bcl-2, heat shock protein 72, glial cell line-derived neurotrophic factor (GDNF), and hepatocyte growth factor (HGF). Moreover, the development of new vectors and gene delivery systems have been studied. Gene therapy would be a strong strategy for treatment of cerebral infarction in the future.     

Magnetic resonance spectroscopy in cerebral ischemia and infarction

Proton magnetic resonance spectroscopy (MRS) and spectroscopic imaging (MRSI) are promising techniques for the noninvasive investigation of brain metabolism in vivo. They can be implemented routinely on most clinical scanners, and typically have a spatial resolution of approximately 1 to 10 cm³ with scan times of 5 to 20 minutes. Various compounds can be detected in proton MRS of the brain. Compounds that are of particular importance in cerebrovascular disease are lactate (as a marker of ischemia) and N-acetyl aspartate (NAA), which is believed to be primarily of neuronal/axonal origin. The time-course of the changes in these compounds during ischemia is blood-flow dependent and potentially could be used to stratify acute stroke patients into different treatment protocols and to monitor the effects of treatment. However, many technical challenges have to be overcome (in particular, the development of fast MRSI techniques to reduce scan times) before this goal is realized. Also, more research is required to understand the significance of spectral changes during ischemia, and to compare the relative value of MRSI with other emerging MRI techniques, such as diffusion- and perfusion-weighted MRI.