Emerging experimental therapies for intracerebral hemorrhage: targeting mechanisms of secondary brain injury
Emerging experimental therapies for intracerebral hemorrhage: targeting mechanisms of secondary brain injury
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DOI：
10.3171/2013.2.focus1317
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发表时间：
2013-05-01
影响因子：
4.1
通讯作者：
Mack, William J.
中科院分区：
文献类型：
--
作者：
Belur, Praveen K.;Chang, Jason J.;Mack, William J.
脑出血（ICH）的发病率和死亡率高于其他卒中亚型。尽管有这种负担，目前批准的治疗方法已证明疗效有限。迄今为止，治疗策略主要针对血肿扩张和由此产生的肿块效应。然而，脑损伤的继发机制被认为是ICH后细胞死亡和神经学结局的关键效应子。本文综述了继发性脑损伤相关的脑出血的病理生理学，检查相关的实验模型，并强调了新兴的治疗策略。讨论的治疗范例包括凝血酶抑制剂、去铁胺、米诺环素、他汀类药物、粒细胞集落刺激因子和治疗性低温。尽管有很好的实验和初步的人体数据，但在有效的临床转化之前，还需要进一步的研究。
Intracerebral hemorrhage (ICH) is associated with a higher degree of morbidity and mortality than other stroke subtypes. Despite this burden, currently approved treatments have demonstrated limited efficacy. To date, therapeutic strategies have principally targeted hematoma expansion and resultant mass effect. However, secondary mechanisms of brain injury are believed to be critical effectors of cell death and neurological outcome following ICH. This article reviews the pathophysiology of secondary brain injury relevant to ICH, examines pertinent experimental models, and highlights emerging therapeutic strategies. Treatment paradigms discussed include thrombin inhibitors, deferoxamine, minocycline, statins, granulocyte-colony stimulating factors, and therapeutic hypothermia. Despite promising experimental and preliminary human data, further studies are warranted prior to effective clinical translation.