Hyperglycemia, insulin, and acute ischemic stroke - A mechanistic justification for a trial of insulin infusion therapy
Hyperglycemia, insulin, and acute ischemic stroke - A mechanistic justification for a trial of insulin infusion therapy
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DOI：
10.1161/01.str.0000195175.29487.30
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发表时间：
2006-01-01
期刊：
影响因子：
8.3
通讯作者：
Dandona, P
中科院分区：
文献类型：
--
作者：
Garg, R;Chaudhuri, A;Dandona, P
背景和目的——高血糖与急性缺血性卒中死亡率和发病率增加有关。综述-高血糖诱导促氧化和促炎症状态，可直接引起神经元毒性。高血糖介导的基质金属蛋白酶-9升高可通过增加脑水肿引起神经元损伤。此外，在急性缺血性卒中中，高血糖可能导致促凝状态，从而进一步损害半影区的血液供应。胰岛素输注的作用与高血糖相反。它不仅降低血糖水平，还具有抗氧化和抗炎作用。胰岛素也能改善一氧化氮的产生，从而改善缺血区域的血液循环。本文主要讨论葡萄糖的有害作用和胰岛素的有益作用的潜在机制。结论：在缺乏其他潜在的有益疗法的情况下，迫切需要开展胰岛素输注治疗急性缺血性卒中的试验。
Background and Purpose - Hyperglycemia is associated with increased mortality and morbidity in acute ischemic stroke.Summary of Review - Hyperglycemia induces a pro-oxidative and proinflammatory state that can cause direct neuronal toxicity. Hyperglycemia-mediated increase in matrix metalloproteinase-9 can cause neuronal damage by an increase in cerebral edema. Moreover, hyperglycemia may be responsible for a procoagulant state that can further compromise blood supply to the penumbral areas in acute ischemic stroke. Insulin infusion has an effect that is opposite to that of hyperglycemia. It not only lowers blood glucose levels but also exerts an antioxidant and anti-inflammatory effect. Insulin also improves NO production and results in improved blood circulation to the ischemic areas. This article focuses on the potential mechanisms underlying the injurious effects of glucose and the beneficial effects of insulin.Conclusions - In the absence of other potential beneficial therapies, there is an urgency to institute trials with insulin infusion in acute ischemic stroke.