缺血性脑卒中后脑水肿的研究进展  

Research progress of cerebral edema after ischemic stroke

作　　者：刘流 张华[1] 莫永佳 万荣欢 LIU Liu;ZHANG Hua;MO Yongjia;WAN Ronghuan(Department of Imaging,the Third Affiliated Hospital of Nanchang University,Nanchang First Hospital,Jiangxi Province,Nanchang330008,China)

机构地区：[1]南昌大学第三附属医院、南昌市第一医院影像科,江西南昌330008

出　　处：《中国当代医药》2023年第7期29-34,共6页China Modern Medicine

基　　金：江西省研究生创新专项资金立项项目(YC2021-S196);江西省南昌市重点实验室建设计划项目(洪科字[2021]200号)。

摘　　要：脑水肿是指脑实质内液体异常聚集的一种病理状态。引起脑水肿的原因包括脑卒中、脑出血、创伤、感染及肿瘤等,其中缺血性脑卒中是引起脑水肿的常见原因。缺血性脑卒中引起的脑水肿根据演变过程可分为早期的细胞毒性脑水肿、随后的离子性脑水肿以及最后且最严重的血管源性脑水肿。细胞毒性脑水肿和血管性脑水肿的研究已相对较透彻。细胞毒性脑水肿的形成与钠泵介导的原发性主动转运停止、Na-K-Cl离子通道及SUR1-调控NCCa-ATP通道等离子通道被激活有关;血管性脑水肿的形成与血脑屏障被破坏导致血管通透性增加有关。而目前国内外关于离子性脑水肿的文献相对很少。近些年脑内胶质淋巴系统的发现使离子性脑水肿的发生机制取得一些突破性进展。离子性脑水肿的产生很可能与脑室系统中的脑脊液进入脑实质有关,减少急性缺血性脑卒中患者脑室系统中的脑脊液进入脑实质或许能成为治疗脑水肿的一种新手段。本文在介绍细胞毒性脑水肿及血管性脑水肿的发病机制、影像学表现及治疗等方面的进展外,着重介绍离子性脑水肿的发生机制、影像学表现及治疗等最新进展。Cerebral edema is a kind of pathological state of abnormal accumulation of fluid in the brain parenchyma.The causes of cerebral edema include cerebral ischemia,cerebral hemorrhage,trauma,infections and cancers.Ischemic stroke is the common cause of brain edema.Cerebral edema occurs in three distinct phases separately over time:the early cytotoxic edema phase,the subsequent ionic edema phase,and the later vasogenic edema phase.Cytotoxic edema and vascular edema have been relatively well studied and there are many literatures about them at home and abroad.The formation of cytotoxic edema is related to the cessation of primary active transport mediated by sodium pump,the activation of Na-K-Cl ion channel and SUR1-regulated NCCa-ATP channel.And the formation of vasogenic edema is related to the increased vascular permeability caused by the disruption of blood-brain barrier.But there are few literatures about ionic edema.In recent years,owing to the discovery of the glymphatic system,some breakthrough progress has been made in the mechanism of ionic edema.It studied that the occurrence of ionic edema is probably related to the entry of cerebrospinal fluid in the ventricular system into the brain parenchyma.Reducing the entry of cerebrospinal fluid in the ventricular system into the brain parenchyma in patients with acute ischemic stroke may be a new method for the treatment of brain edema.In this review,this article primarily focus on the latest pathogenesis,imaging characteristics and treatment about cytotoxic edema and vascular edema,at the same time,the latest progress about ionic edema is emphasized.

关 键 词：缺血性脑卒中 离子性脑水肿 血管周围间隙 脑脊液 水通道蛋白4 

分 类 号：R743.3[医药卫生—神经病学与精神病学]