CURRENT CONCEPTS OF BRAIN EDEMA - REVIEW OF LABORATORY INVESTIGATIONS
CURRENT CONCEPTS OF BRAIN EDEMA - REVIEW OF LABORATORY INVESTIGATIONS
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DOI：
10.3171/jns.1995.83.6.1051
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发表时间：
1995-12-01
影响因子：
4.1
通讯作者：
KIMELBERG, HK
中科院分区：
文献类型：
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作者：
KIMELBERG, HK
自1967年以来，克拉茨奥（Klatzo）将脑水肿分为血管源性和细胞毒性两种类型的分类方法已被广泛应用。前者是由于血脑屏障（BBB）开放，液体从血管进入导致整体脑肿胀，而后者是指细胞肿胀但血脑屏障的正常不渗透性没有丧失。这篇综述主要涵盖了一些新的研究成果，这些成果确定了星形胶质细胞的细胞内肿胀是在许多不同类型的脑损伤中所见的细胞毒性水肿的一种主要形式。由于“水肿”这个术语广为人知，应该予以保留；然而，因为这种细胞内肿胀通常不是对毒素的反应，所以有人建议“细胞性水肿”这个术语比“细胞毒性水肿”更可取。文中讨论了在临床上测量细胞性水肿所涉及的困难，并认为不太可能存在一种“纯粹”的水肿形式。强调血管源性水肿和细胞性水肿的机制及直接后果差异很大，它们之间的联系主要是语义上的。体外研究已经确定了星形胶质细胞肿胀的几种潜在的有害继发性后果。其中最重要的一种似乎可能是肿胀的星形胶质细胞释放兴奋性氨基酸增加。在体外已经确定了抑制氨基酸释放增加的潜在机制，并且可能在治疗上有用。
Klatzo's classification of brain edema into two types, vasogenic and cytotoxic, has been in general use since 1967. The former involves overall brain swelling due to fluid entry from the vasculature because of openings in the blood-brain barrier (BBB), whereas the latter refers to cell swelling without any loss of the normal impermeability of the BBB. This review principally covers new work that identifies the intracellular swelling of astrocytes as a major form of cytotoxic edema seen in many different kinds of brain injury. The term edema should be retained because of its familiarity; however, because such intracellular swelling is usually not a response to toxins, it is suggested that the term cellular edema is preferable to cytotoxic edema. The difficulties involved in measuring cellular edema clinically are discussed, and the belief that a ''pure'' form of either edema is unlikely to exist. It is emphasized that the mechanisms and direct consequences of vasogenic and cellular edema are so different that the connection is mainly semantic. Studies conducted in vitro have identified several potentially damaging secondary consequences of astrocytic swelling. One of the most important of these seems likely to be the increased release of excitatory amino acids from swollen astrocytes. Potential mechanisms for inhibition of the increased release of amino acids have been identified in vitro and could prove therapeutically useful.