Response to Stevens et al. Glucose Dynamics of Cortical Spreading Depolarization in Acute Brain Injury: A Systematic Review (DOI: 10.1089/neu.2018.6175).
Response to Stevens et al. Glucose Dynamics of Cortical Spreading Depolarization in Acute Brain Injury: A Systematic Review (DOI: 10.1089/neu.2018.6175).
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对史蒂文斯等人的回应
DOI：
10.1089/neu.2019.6599
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发表时间：
2020
影响因子：
4.2
通讯作者：
Hurst T
中科院分区：
文献类型：
--
作者：
Hurst T
在第二篇文章中，我们（1）发现去极化次数与平均血糖之间存在高度显著的关系。（p< 0.001）的平均值（图1 [经许可转载]，其中我们将SD的发生率作为因变量），以及（2）在导言2中提出了“恶性循环”的可能性其中通过去极化导致大脑皮层组织葡萄糖耗尽将挑战皮层能量状态并使神经元膜不稳定，因此倾向于进一步去极化。该关系的参数的含义是（1）葡萄糖利用率最大（从而受到血浆可用性的限制）和（2）如果血糖保持在8.8 mmol/L（160 mg/100 mL）范围内，则预期去极化可能停止，从而提高了在临床中采用类似治疗方法的可能性。考虑到现在认为影响SD频率的各种因素，如动脉低血压，体温，以及我们认为的局部组织氧分压，SD发病率取决于血浆-或者更好的是，脑组织葡萄糖-的想法只能在这些其他影响保持稳定，而血浆葡萄糖也稳定时进行测试，这不是一件容易的事。
In the second of these articles3 we (1) found a highly significant relationship between number of depolarizations and mean plasma glucose (p< 0.001)(Fig. 1 [reproduced with permission] in which we treated incidence of SDs as the dependent variable), and (2) suggested in the Introduction2 the possibility of a “vicious circle” in which depletion of cerebral cortical tissue glucose by depolarization would challenge cortical energy state and destabilize neuronal membranes, hence predisposing to further depolarizations. The implications of the parameters of the relationship are (1) that glucose utilization rate is maximal (so as to have become limited by plasma availability) and (2) that depolarizations might be expected to cease if plasma glucose were to remain in the region of 8.8 mmol/L (160 mg/100 mL), raising the possibility of a similar treatment approach in the clinic. Given the various factors now believed to influence SD frequency, such as arterial hypotension, body temperature, and, we would suggest, local tissue oxygen tension, the idea of SD incidence being dependent on plasma–or, much better, brain tissue glucose–can only be tested when these other influences are held stable while plasma glucose is also steady, which is no easy task.