Eisenhut Michael
Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton LU4ODZ, UK.
Int J Inflam. 2014;2014:509707. doi: 10.1155/2014/509707. Epub 2014 Dec 29.
All forms of cerebral inflammation as found in bacterial meningitis, cerebral malaria, brain injury, and subarachnoid haemorrhage have been associated with vasospasm of cerebral arteries and arterioles. Vasospasm has been associated with permanent neurological deficits and death in subarachnoid haemorrhage and bacterial meningitis. Increased levels of interleukin-1 may be involved in vasospasm through calcium dependent and independent activation of the myosin light chain kinase and release of the vasoconstrictor endothelin-1. Another key factor in the pathogenesis of cerebral arterial vasospasm may be the reduced bioavailability of the vasodilator nitric oxide. Therapeutic trials in vasospasm related to inflammation in subarachnoid haemorrhage in humans showed a reduction of vasospasm through calcium antagonists, endothelin receptor antagonists, statins, and plasminogen activators. Combination of therapeutic modalities addressing calcium dependent and independent vasospasm, the underlying inflammation, and depletion of nitric oxide simultaneously merit further study in all conditions with cerebral inflammation in double blind randomised placebo controlled trials. Auxiliary treatment with these agents may be able to reduce ischemic brain injury associated with neurological deficits and increased mortality.
在细菌性脑膜炎、脑型疟疾、脑损伤和蛛网膜下腔出血中发现的所有形式的脑部炎症都与脑动脉和小动脉的血管痉挛有关。在蛛网膜下腔出血和细菌性脑膜炎中，血管痉挛与永久性神经功能缺损和死亡有关。白细胞介素-1水平升高可能通过钙依赖性和非依赖性激活肌球蛋白轻链激酶以及释放血管收缩剂内皮素-1而参与血管痉挛。脑动脉血管痉挛发病机制中的另一个关键因素可能是血管舒张剂一氧化氮的生物利用度降低。针对人类蛛网膜下腔出血中与炎症相关的血管痉挛的治疗试验表明，通过钙拮抗剂、内皮素受体拮抗剂、他汀类药物和纤溶酶原激活剂可减少血管痉挛。在双盲随机安慰剂对照试验中，同时针对钙依赖性和非依赖性血管痉挛、潜在炎症以及一氧化氮消耗的治疗方式组合，在所有脑部炎症情况下都值得进一步研究。用这些药物进行辅助治疗可能能够减少与神经功能缺损和死亡率增加相关的缺血性脑损伤。
