Kadhim Hazim J, Duchateau Jean, Sébire Guillaume
Neuropathology Unit (Anatomic Pathology Service), Brugmann University Hospital and Pediatrics Service, Queen Fabiola Children's University Hospital, Free University of Brussels, Belgium.
J Intensive Care Med. 2008 Jul-Aug;23(4):236-49. doi: 10.1177/0885066608318458. Epub 2008 May 25.
The brain reacts to injury or disease by cascades of cellular and molecular responses. Evidence suggests that immune-inflammatory processes are key elements in the physiopathological processes associated with brain injury or damage. Cytokines are among major mediators implicated in these processes. Cytokine responses in the initial phase of brain injury might have a role in aggravating brain damage. However, in later stages, these molecular mediators might contribute to recovery or repair. Hemodynamic stabilization and optimalization of oxygen delivery to the brain remain cornerstones in the management of acute brain injury. New approaches might use anticytokine therapy to limit progression and halt or attenuate secondary brain damage. Progress toward such novel neuroprotection strategies, however, awaits better understanding of the optimal timing and dosing of those neuromodulatory therapies and better knowledge of the numerous interactions of those mediators. This also requires understanding of how and when precisely immune mechanisms shift from noxious to protective or restorative actions.
大脑通过一系列细胞和分子反应对损伤或疾病作出反应。有证据表明，免疫炎症过程是与脑损伤或损害相关的病理生理过程中的关键因素。细胞因子是参与这些过程的主要介质之一。脑损伤初始阶段的细胞因子反应可能在加重脑损伤方面起作用。然而，在后期阶段，这些分子介质可能有助于恢复或修复。血流动力学稳定以及优化向大脑的氧气输送仍然是急性脑损伤管理的基石。新方法可能会使用抗细胞因子疗法来限制病情进展并阻止或减轻继发性脑损伤。然而，要实现这种新型神经保护策略，还需要更好地了解这些神经调节疗法的最佳时机和剂量，以及对这些介质之间众多相互作用有更深入的认识。这也需要了解免疫机制如何以及何时准确地从有害作用转变为保护或恢复作用。
