Role of the vascular endothelium and plaque in acute ischemic stroke
Role of the vascular endothelium and plaque in acute ischemic stroke
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DOI：
10.1212/wnl.0b013e3182695836
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发表时间：
2012-09-01
期刊：
影响因子：
9.9
通讯作者：
Madden, Jane A.
中科院分区：
文献类型：
--
作者：
Madden, Jane A.
中风的根本原因在于动脉内皮细胞层的损伤。最严重的损害是由于动脉粥样硬化，它可以阻塞动脉或产生血栓栓塞。糖尿病和炎症通过启动和促进内皮下层修饰脂质的沉积以及抑制内皮细胞一氧化氮（NO）的产生，从而导致动脉粥样硬化和相关的内皮损伤。同时，内皮素-1的生成和活性氧的生成都增加。此外，白细胞粘附内皮细胞，c反应蛋白水平升高。脑动脉闭塞或斑块破裂引起的中风会继续并加剧内皮损伤。他汀类药物已被证明有助于预防中风并减少其后果。目前正在进行一项国际临床试验，以确定一氧化氮供体是否有效（卒中研究中一氧化氮的疗效）。其他干预措施，如抗氧化剂，rho激酶抑制和内皮祖细胞提供了有希望的研究途径，也许是治疗中风的治疗途径。本文讨论了血管内皮在缺血性卒中中的作用，以及那些可能为未来治疗提供合理途径的干预措施。神经病学(R) 2012；79（增刊1）：S58-S62
The underlying cause of stroke lies in the damage to the arterial endothelial cell layer. The most profound damage is due to atherosclerosis, which can either occlude an artery or produce a thromboembolism. Diabetes and inflammation contribute to atherosclerosis and the associated endothelial damage by initiating and promoting the deposition of modified lipids in the subendothelium and by inhibiting endothelial nitric oxide (NO) production. At the same time, both production of endothelin-1 and generation of reactive oxygen species increase. In addition, leukocytes adhere to the endothelium and levels of C-reactive protein increase. The stroke that ensues upon cerebral artery occlusion or plaque rupture continues and exacerbates endothelial damage. Statins have been shown to be helpful in preventing stroke and diminishing its consequences. An international clinical trial to determine if an NO donor is effective (Efficacy of Nitric Oxide in Stroke study) is currently under way. Other interventions such as antioxidants, rho kinase inhibition, and endothelial progenitor cells offer promising avenues of research and perhaps therapeutic avenues for treatment of stroke. This article discusses the role of the vascular endothelium in ischemic stroke and those interventions that may provide plausible avenues for future therapy. Neurology (R) 2012; 79 (Suppl 1):S58-S62