Ischemic Conditioning and neonatal hypoxic ischemic encephalopathy: a literature review.
Ischemic Conditioning and neonatal hypoxic ischemic encephalopathy: a literature review.
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发表时间：
2017-12
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通讯作者：
Dusit Adstamongkonkul;D. Hess
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作者：
Dusit Adstamongkonkul;D. Hess
缺氧缺血性脑病（HIE）是新生儿期严重缺氧脑损伤的结果，可导致终生发病率和过早死亡。目前，出生后立即低温治疗是临床相关HIE的标准治疗方法。然而，单纯的治疗性低温并不能提供完全的神经保护，迫切需要辅助治疗。缺血调节是一种内源性保护的适应性过程，其中小剂量的亚致死性缺血可以提供对致死性缺血事件的保护。远端缺血后适应（Remote Ischemic Post-conditioning， RIPC）是一种缺血条件适应，对于出生后立即诊断的HIE具有高度可翻译性，因为在致死性缺血发作后，条件缺血刺激被应用于肢体。许多对新生大鼠的研究表明，RIPC在减轻局灶性脑缺血模型的损伤和改善神经预后方面是有效的。在这篇综述中，我们重点介绍了关于HIE的现有数据及其目前的治疗方法，HIE研究的模型，缺血适应/RIPC及其机制。我们特别讨论了RIPC对新生儿HIE脑的影响。我们假设将RIPC与标准的低温治疗相结合可能是治疗HIE的一种有吸引力的方法。
Hypoxic Ischemic Encephalopathy (HIE) is the result of severe anoxic brain injury during the neonatal period and causes life-long morbidity and premature mortality. Currently, therapeutic hypothermia immediately after birth is the standard of care for clinically relevant HIE. However, therapeutic hypothermia alone does not provide complete neuroprotection and there is an urgent need for adjunctive therapies. Ischemic conditioning is an adaptive process of endogenous protection in which small doses of sub-lethal ischemia can provide a protection against a lethal ischemic event. Remote Ischemic Post-conditioning (RIPC), a form of ischemic conditioning, is highly translatable for HIE diagnosed immediately after birth as the conditioned ischemic stimulus is applied at the limb after the lethal ischemic episode. A number of studies in neonatal rats have demonstrated that RIPC is effective at reducing injury in focal cerebral ischemia models and improves neurological outcomes. In this review, we focus on the available data on HIE and its current treatment, models in HIE studies, ischemic conditioning/RIPC and its mechanism. We discuss in particular the effect of RIPC on neonatal brain with HIE. We postulate that combining RIPC with standard therapeutic hypothermia can be an attractive therapeutic approach for HIE.