Stein Donald G, Wright David W, Kellermann Arthur L
Brain Research Laboratory, Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA.
Ann Emerg Med. 2008 Feb;51(2):164-72. doi: 10.1016/j.annemergmed.2007.05.001. Epub 2007 Jun 22.
In this article, we review published preclinical and epidemiologic studies that examine progesterone's role in the central nervous system. Its effects on the reproductive and endocrine systems are well known, but a large and growing body of evidence, including a recently published pilot clinical trial, indicates that the hormone also exerts neuroprotective effects on the central nervous system. We now know that it is produced in the brain, for the brain, by neurons and glial cells in the central and peripheral nervous system of both male and female individuals. Laboratories around the world have reported that administering relatively large doses of progesterone during the first few hours to days after injury significantly limits central nervous system damage, reduces loss of neural tissue, and improves functional recovery. Although the research published to date has focused primarily on progesterone's effects on blunt traumatic brain injury, there is evidence that the hormone affords protection from several forms of acute central nervous system injury, including penetrating brain trauma, stroke, anoxic brain injury, and spinal cord injury. Progesterone appears to exert its protective effects by protecting or rebuilding the blood-brain barrier, decreasing development of cerebral edema, down-regulating the inflammatory cascade, and limiting cellular necrosis and apoptosis. All are plausible mechanisms of neuroprotection.
在本文中，我们回顾了已发表的临床前和流行病学研究，这些研究探讨了孕酮在中枢神经系统中的作用。其对生殖和内分泌系统的影响是众所周知的，但大量且不断增加的证据，包括最近发表的一项初步临床试验表明，这种激素对中枢神经系统也具有神经保护作用。我们现在知道，它由男性和女性个体中枢和外周神经系统中的神经元和神经胶质细胞在大脑中产生，为大脑所用。世界各地的实验室报告称，在损伤后的最初数小时至数天内给予相对大剂量的孕酮，可显著限制中枢神经系统损伤，减少神经组织损失，并改善功能恢复。尽管迄今为止发表的研究主要集中在孕酮对钝性颅脑损伤的影响上，但有证据表明，这种激素能对多种形式的急性中枢神经系统损伤提供保护，包括穿透性脑外伤、中风、缺氧性脑损伤和脊髓损伤。孕酮似乎通过保护或重建血脑屏障、减少脑水肿的发展、下调炎症级联反应以及限制细胞坏死和凋亡来发挥其保护作用。所有这些都是合理的神经保护机制。
