Yunoki Masatoshi, Kanda Takahiro, Suzuki Kenta, Uneda Atsuhito, Hirashita Koji, Yoshino Kimihiro
Department of Neurosurgery, Kagawa Rosai Hospital.
Neurol Med Chir (Tokyo). 2017 Nov 15;57(11):590-600. doi: 10.2176/nmc.ra.2017-0062. Epub 2017 Sep 27.
Ischemic tolerance is an endogenous neuroprotective phenomenon induced by sublethal ischemia. Ischemic preconditioning (IPC), the first discovered form of ischemic tolerance, is widely seen in many species and in various organs including the brain and the spinal cord. Ischemic tolerance of the spinal cord is less familiar among neurosurgeons, although it has been reported from the viewpoint of preventing ischemic spinal cord injury during aortic surgery. It is important for neurosurgeons to have opportunities to see patients with spinal cord ischemia, and to understand ischemic tolerance of the spinal cord as well as the brain. IPC has a strong neuroprotective effect in animal models of ischemia; however, clinical application of IPC for ischemic brain and spinal diseases is difficult because they cannot be predicted. In addition, one drawback of preconditioning stimuli is that they are also capable of producing injury with only minor changes to their intensity or duration. Numerous methods to induce ischemic tolerance have been discovered that vary in their timing and the site at which short-term ischemia occurs. These methods include ischemic postconditioning (IPoC), remote ischemic preconditioning (RIPC), remote ischemic perconditioning (RIPerC) and remote ischemic postconditioning (RIPoC), which has had a great impact on clinical approaches to treatment of ischemic brain and spinal cord injury. Especially RIPerC and RIPoC to induce spinal cord tolerance are considered clinically useful, however the evidence supporting these methods is currently insufficient; further experimental or clinical research in this area is thus necessary.
缺血耐受是一种由亚致死性缺血诱导的内源性神经保护现象。缺血预处理（IPC）是最早发现的缺血耐受形式，在许多物种以及包括脑和脊髓在内的各种器官中广泛存在。尽管从预防主动脉手术期间缺血性脊髓损伤的角度已有报道，但脊髓的缺血耐受在神经外科医生中并不那么为人所熟知。对于神经外科医生来说，有机会诊治脊髓缺血患者并了解脊髓以及脑的缺血耐受情况很重要。IPC在缺血动物模型中具有强大的神经保护作用；然而，由于缺血性脑和脊髓疾病难以预测，IPC在这些疾病临床应用方面存在困难。此外，预处理刺激的一个缺点是，仅对其强度或持续时间进行微小改变就可能产生损伤。已经发现了许多诱导缺血耐受的方法，这些方法在短期缺血发生的时间和部位上各不相同。这些方法包括缺血后处理（IPoC）、远程缺血预处理（RIPC）、远程缺血预适应（RIPerC）和远程缺血后处理（RIPoC），它们对缺血性脑和脊髓损伤的临床治疗方法产生了重大影响。特别是诱导脊髓耐受的RIPerC和RIPoC被认为具有临床应用价值，然而目前支持这些方法的证据不足；因此有必要在该领域开展进一步的实验或临床研究。
