Glucocorticoids and the Brain after Critical Illness.
Glucocorticoids and the Brain after Critical Illness.
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糖皮质激素和危重病后的大脑。
DOI：
10.1210/endocr/bqaa242
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发表时间：
2021-03-01
期刊：
影响因子：
4.8
通讯作者：
Spencer-Segal JL
中科院分区：
文献类型：
--
作者：
Hill AR;Spencer-Segal JL
危重病的治疗通常侧重于患者的短期身体恢复;然而，最近的工作扩大了我们对疾病和治疗策略的长期影响的理解。特别是，危重病幸存者发生持久性认知障碍和精神障碍的风险显著增加。在这篇综述中，我们研究了内源性和外源性糖皮质激素在危重病后神经精神预后中的作用。疾病的特征是游离皮质醇和促肾上腺皮质激素抑制的急性升高，通常在恢复后恢复正常;然而，有时会发生长期的失调。高水平的糖皮质激素可导致海马和前额皮质的可塑性和结构完整性的持久改变，这种机制可能会导致危重病幸存者的记忆和认知受损，尽管缺乏具体的证据。糖皮质激素也可能加重炎症相关的神经损伤。相反，目前的证据表明，在疾病期间糖皮质激素可能会防止创伤后应激障碍的发展。我们提出了这一领域未来的研究方向，包括确定疾病后糖皮质激素持续升高在神经精神疾病结局中的作用，全身性与神经炎症的作用，以及探索盐皮质激素受体和肠-脑轴作用的未探索研究路线。在这一领域，个性化医疗的进展有可能为重症患者（包括2019年冠状病毒病）的生活带来切实的改善。
Treatment for critical illness typically focuses on a patient’s short-term physical recovery; however, recent work has broadened our understanding of the long-term implications of illness and treatment strategies. In particular, survivors of critical illness have significantly elevated risk of developing lasting cognitive impairment and psychiatric disorders. In this review, we examine the role of endogenous and exogenous glucocorticoids in neuropsychiatric outcomes following critical illness. Illness is marked by acute elevation of free cortisol and adrenocorticotropic hormone suppression, which typically normalize after recovery; however, prolonged dysregulation can sometimes occur. High glucocorticoid levels can cause lasting alterations to the plasticity and structural integrity of the hippocampus and prefrontal cortex, and this mechanism may plausibly contribute to impaired memory and cognition in critical illness survivors, though specific evidence is lacking. Glucocorticoids may also exacerbate inflammation-associated neural damage. Conversely, current evidence indicates that glucocorticoids during illness may protect against the development of post-traumatic stress disorder. We propose future directions for research in this field, including determining the role of persistent glucocorticoid elevations after illness in neuropsychiatric outcomes, the role of systemic vs neuroinflammation, and probing unexplored lines of investigation on the role of mineralocorticoid receptors and the gut–brain axis. Progress toward personalized medicine in this area has the potential to produce tangible improvements to the lives patients after a critical illness, including Coronavirus Disease 2019.
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DOI：
10.1056/nejmoa1214969
发表时间：
2013-04-18
期刊：
The New England journal of medicine
影响因子：
--
作者：
Boonen E;Vervenne H;Meersseman P;Andrew R;Mortier L;Declercq PE;Vanwijngaerden YM;Spriet I;Wouters PJ;Vander Perre S;Langouche L;Vanhorebeek I;Walker BR;Van den Berghe G
通讯作者：
Van den Berghe G
影响因子：
3.7
作者：
Bentz, Dorothee;Michael, Tanja;de Quervain, Dominique J. -F.
通讯作者：
de Quervain, Dominique J. -F.
DOI：
10.1186/cc13084
发表时间：
2013-10-29
期刊：
Critical care (London, England)
影响因子：
--
作者：
Abelha FJ;Luís C;Veiga D;Parente D;Fernandes V;Santos P;Botelho M;Santos A;Santos C
通讯作者：
Santos C
影响因子：
5.7
作者：
Chavan, Sangeeta S.;Huerta, Patricio T.;Diamond, Betty
通讯作者：
Diamond, Betty
影响因子：
2.9
作者：
Cordero, MI;Sandi, C
通讯作者：
Sandi, C