亚低温对脑梗死后AQP4表达及血脑屏障通透性的影响

局部亚低温治疗重症脑梗死的临床疗效分析【摘要】目的分析局部亚低温在重症脑梗死治疗中的作用及临床疗效。

方法80例重症脑梗死患者随机分为两组,治疗组40例,早期予局部亚低温治疗加常规治疗;对照组40例,仅予常规治疗。

治疗前后两组均予临床疗效定及神经功能缺损评分(NDS)。

结果治疗组第1、2周患者神经功能缺损评分较对照组降低(P＜0.05)。

治疗组临床疗效优于对照组(P＜0.05)。

结论早期局部亚低温在重症脑梗死治疗的治疗中有重要作用,能显著改善预后。

【Abstract】Objective To observe the effect of the local mild hypothermia in the treatment of severe cerebral infraction.Methods 80 cases of severe cerebral infraction were randomly allocated to two groups,treatment group(40 cases)received conventional treatment plus local mild hypothermia at early stage,while control group(40 cases)only accepted conventional treatment,stroke scale(NDS)andclinical effect were compared at different times before and after treatment in two groups.Results NDS of treatment group decreased at1,2weeks(P＜0.05).The Clinical effect of treatment group was better than control group(P＜0.05).Conclusion The early local mild hypothermia is important in the treatment of severe cerebral infraction and significantly improve prognosis of severe cerebral infraction patients.【Key words】Local mild hypothermia; Severe cerebral infraction; Early重症脑梗死起病急,临床治疗效果差,致残率及致死率高,而亚低温有保护脑细胞,减轻细胞损伤的作用,目前临床上有较多全身亚低温治疗脑卒中的报道,但该法费用高,不良反应大。

文章编号：1003-2754（2011）08-0680-05亚低温对缺氧/复氧条件下星型胶质细胞AQP4表达的影响樊红彬，刘君，董瑞国收稿日期：2011-04-01；修订日期：2011-08-05作者单位：（徐州医学院附属医院神经内科，江苏徐州221002）通讯作者：董瑞国，Email ：DongRG ＜rg _dong@163．com 摘要：目的探讨亚低温对缺氧/复氧条件下星形胶质细胞（astrocytes ，AS ）AQP4表达变化的影响。

方法分离新生24h 内的SD 大鼠皮质，进行星形胶质细胞培养，分为正常对照组（C ）、常温缺氧/复氧组（H ）、亚低温干预缺氧/复氧组（M ）。

用台盼蓝染色法测定37ħ及32ħ时缺氧/复氧不同时间点AS 的存活率，对细胞进行形态学观察，应用细胞免疫化学技术检测缺氧/复氧各个时间点AQP4的表达水平。

结果（1）与对照组比较，常温组缺氧后4h 及8h 有少量细胞死亡（P ＜0．05），随着复氧时间延长死亡细胞数亦逐渐增多（P ＜0．01）；缺氧4h 及8h 时，亚低温组细胞死亡数与常温组比较无明显差异，从复氧4h 开始，亚低温组细胞死亡数明显少于常温组（P ＜0．05）。

（2）常温组缺氧4h 及8h 后，AQP4阳性表达细胞数减少（P ＜0．01），而复氧后AQP4阳性表达细胞数逐渐升高并随时间延长呈增高趋势（P ＜0．01）。

至复氧后8h ，亚低温组缺氧/复氧时AQP4阳性表达细胞数均较常温组减少（P ＜0．05）。

结论亚低温干预条件下，星形胶质细胞AQP4表达水平降低，可能是亚低温神经保护作用机制之一。

关键词：星形胶质细胞；AQP4；亚低温；缺氧/复氧中图分类号：R743文献标识码：AEffect of mild hypothermia on the aquaporin 4expressions in astrocytes under the condition of hypoxia /reoxygen-ationFAN Hong-bin ，LIU Jun ，DONG Rui-guo．（Department of Neurology ，Affiliated Hospital of Xuzhou Medical College ，Xuzhou 221002，China ）Abstract ：ObjectiveTo explore the effect of mild hypothermia on the AQP4expressions in astrocytes under thecondition of hypoxia /reoxygenation．MethodsThe primary and subculture cells from the cortex of SD fetal rat （less than24h ）were divided into three groups ：normal control group （C ），hypoxia /reoxygenation group （H ）and mild hypothermia hy-poxia /reoxygenation group （M ）．Trypan blue staining was used to detect the survival rate of astrocytes and changes of all the time points in hypoxia /reoxygenation ，inverted phase contrast microscope were used to observe the cells ，and immunocy-tochemistry was adopted to examine the expression changes of AQP4in the astrocytes at some indicated time points after hy-poxia /reoxygenation．ResultsCompared with controls ，hypoxia /reoxygenation group had fewer cell death after 4h and 8h ofhypoxia ，and the cell death increased gradually after reoxygenation．Compared with hypoxia /reoxygenation group ，the cell death of mild hypothermia hypoxia /reoxygenation group did not change significantly after 4h and 8h of hypoxia and de-creased significantly after 4h of reoxygenation．The expression of AQP4showed a tendency to decrease to normal contrast group after 8h of hypoxia in 37ħ，but increased after reoxygenation and showed a rising trend with time．Compared with hy-poxia /reoxygenation group ，mild hypothermia decreased the expression of AQP4from beginning of hypoxia to 8h after reoxy-genation．ConclusionUnder the mild hypothermia conditions ，astrocytes AQP4expression level is reduced ，and it may bethe one of the possible mechanisms of mild hypothermia neuroprotection．Key words ：Astrocytes ；AQP4；Mild hypothermia ；Hypoxia /reoxygenation脑水肿是缺血性脑血管病的一个重要病理过程，严重影响着预后，对脑水肿的形成机制及防治方法的研究具有重要意义。

亚低温对局灶脑缺血再灌注后脑血流、血脑屏障、神经细胞损伤作用的研究【摘要】目的对比研究不同时期亚低温( MHT 32℃±0.2℃)对局灶脑缺血再灌注损伤的作用。

方法64只雄性SD鼠被随机分成常温(NT)、缺血期亚低温(MHTi)、再灌注期亚低温(MHTr)、缺血期加再灌注期亚低温(MHTi+r)四组，并用改良Koizumi's局灶脑缺血模型，分别观察了动物缺血3小时再灌注3小时过程中，缺血周边和核心区局部脑血流 (rCBF)改变，再灌注3小时后血脑屏障(BBB)破坏及再灌注72小时后缺血梗塞灶体积。

结果MHTi+r及MHTi均有改善缺血周边区再灌注后急性高灌注和继发低灌流及核心区持续低灌流、减轻血脑屏障破坏、减少缺血梗塞灶体积的作用。

该作用尤以MHTi+r为明显。

MHTr作用有限。

结论MHTi+r对皮层的保护作用较MHTi好。

由此可推知，局灶脑缺血再灌注损伤是个持续的过程，亚低温治疗不但要考虑开始时间，其持续时间对疗效具有同样重要价值。

【关键词】脑缺血再灌注损伤亚低温The effect of mild hypothermia on cerebral blood flow blood-brain ba rrier and infarct volume after focal cerebral ischemia and reperfusionin r atsHUANG Fengping, ZHOU Liangfu.Dept. of Neurosurgery of HuaShan H os pital, SMU, Shanghai 200040【Abstract】Objective To compare the effects of mild hypothermia(MHT 32℃±0.2℃) induced in different time courses of cere bra l ischemia and reperfusion. Methods 64 male SD r a ts were divided into three mild hypothermic groups, which including intra-ische mi a(MHTi), intra-reperfusion(MHTr), intra-ischemia/reperfusion(MHTi+r) group, an d one normothermic group(NT 37℃±0.2℃) as control. Reversible focal ischemia wa s carried outin rats with modified Koizumi's model. Cortical blood flow was meas ured during 3hr of ischemia following 3hr of reperfusion. The permeability of bl ood-brain barrier(BBB) was estimated after 3hr of ischemia and 3hr of reperfusi o n. The infarct volume was measured at 72hr after reprefusion. Res ults The acute postischemic hyperperfusion and delayed hypoperfusion in ischemic perifocal region and sustained hypoperfusion in ischemic core were inhi bit ed in both MHTi+r and MHTi groups. The disruption of BBB and the infarct volumein the basal ganglia and cortex regions were significantly less in both MHTi+r a nd MHTi groups, especially in the MHTi+r group. The effect of MHTr on prolonged ischemia/reperfusion injury was limited. Conclusion This study demonstrated that MHTi+r has more substantial protective effects on reduc ing ischemia/reperfusion injury than MHTi. These differences between MHTi and MH Ti+r suggest that ischemic and reperfusional injury is an ongoing process, and t he concept of MHT therapeutic window must include not only the time of initiating but also the duration of the intervention.【Key words】Focal cerebral ischemia Reperfusion injury Mild hypothermia脑缺血后再灌注的作用已被广泛研究。