短暂性脑低温可减轻延迟性组织型纤溶酶原激活剂再灌注损伤,并延长其在局灶性栓塞性卒中模型中的治疗时间窗。

Transient brain hypothermia reduces the reperfusion injury of delayed tissue plasminogen activator and extends its therapeutic time window in a focal embolic stroke model.

机构信息

Physiology-Pharmacology Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

College of Science, University of Manitoba, Winnipeg, Canada.

出版信息

Brain Res Bull. 2017 Sep;134:85-90. doi: 10.1016/j.brainresbull.2017.07.007. Epub 2017 Jul 11.

Abstract

It has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether shortIt has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether short-term and mild local brain cooling can prevent hyperemia and/or adverse effects of delayed tPA in rat embolic stroke model. Male animals were subjected to embolic stroke and then randomly classified into control (saline), tPA (1mg/kg; i.v.), local hypothermia (LH), and tPA+LH. The drug was injected at 6 h after ischemia. LH was conducted by direct ipsilateral (injured) hemisphere cooling at 6.5h after stroke and maintained for approximately 30min. Cerebral blood flow was monitored in duration of 60 minute after tPA administration and hyperemic response was measured. Infarct volume, blood-brain barrier (BBB) disruption, edema formation, neurological deficits, and matrix metalloproteinase-9 (MMP-9) level were measured 48 h later. A combination of tPA+LH significantly diminished infarct volume in comparison with the tPA (P< 0.001) and control (P<0.05) groups. Combination therapy also decreased BBB leakage (P<0.001), MMP-9 level or edema (P<0.05) and improved neurological functions at 24 and 48h after stroke. LH caused a gradual decrease in hyperemic response after thrombolysis compared to the control (P<0.05) or tPA (P<0.001) groups. LH alone also reduced infarct volume, BBB leakage or edema (P<0.05). The short-term local brain hypothermia may mitigate reperfusion injury following delayed tPA therapy and extend its time window up to 6h.

摘要

据报道,在缺血性脑卒中溶栓治疗后限制再灌注可能会减少组织型纤溶酶原激活剂(tPA)的不良反应,并延长其时间窗。我们研究了短暂的局部脑低温是否可以预防大鼠栓塞性脑卒中模型中 tPA 延迟再灌注引起的充血和/或不良反应。雄性动物接受栓塞性脑卒中后,随机分为对照组(生理盐水)、tPA(1mg/kg;静脉注射)、局部低温组(LH)和 tPA+LH 组。药物在缺血后 6 小时注射。LH 在脑卒中后 6.5 小时通过直接同侧(损伤)半球冷却进行,并持续约 30 分钟。在 tPA 给药后 60 分钟监测脑血流,并测量充血反应。48 小时后测量梗死体积、血脑屏障(BBB)破坏、水肿形成、神经功能缺损和基质金属蛋白酶-9(MMP-9)水平。与 tPA(P<0.001)和对照组(P<0.05)相比,tPA+LH 联合治疗显著减小了梗死体积。联合治疗还降低了 BBB 渗漏(P<0.001)、MMP-9 水平或水肿(P<0.05),并在脑卒中后 24 和 48 小时改善了神经功能。与对照组(P<0.05)或 tPA 组(P<0.001)相比,LH 在溶栓后引起的充血反应逐渐降低。LH 单独治疗也降低了梗死体积、BBB 渗漏或水肿(P<0.05)。短期局部脑低温可能减轻延迟 tPA 治疗后的再灌注损伤,并将其时间窗延长至 6 小时。

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