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除人类以外的哺乳动物的自然脑动脉瘤和自发性蛛网膜下腔出血:比较医学是否有研究空间?

Natural Cerebral Aneurysm and Spontaneous Subarachnoid Hemorrhage in Mammals Other Than Man: Is There a Scope for Comparative Medicine?

作者信息

Muroi Carl, Hugelshofer Michael, Seehusen Frauke, Keller Emanuela

机构信息

Neurocritical Care Unit, University Hospital Zurich, Zurich, Switzerland.

Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.

出版信息

World Neurosurg. 2019 Feb;122:384-389. doi: 10.1016/j.wneu.2018.11.007. Epub 2018 Nov 15.

Abstract

BACKGROUND

Concepts that showed substantial efficacy in animal models of subarachnoid hemorrhage (SAH) often failed to improve outcome in humans with aneurysmal SAH. The concept of "comparative medicine," an open-minded comparison across species, might offer an alternative to the "constructed" animal models' approach. Naturally occurring diseases in animals might bear more similarity to human diseases than models. In this context, the question arises whether spontaneous intracranial aneurysms exist in animals or not, and whether they cause SAH or not.

METHODS

A systematic literature search was performed. Only articles dealing with natural aneurysms and/or SAH of mammals other than man were included. All articles dealing with induced aneurysms and/or SAH were removed.

RESULTS

Of 2812 screened articles, 9 articles describing natural intracranial aneurysms and/or SAH were found. In total 1979 individual animals of 29 species were examined. Natural intracranial aneurysms were described in 7 individual animals of 6 species. Spontaneous SAH was described in 3 species. In 1 chimpanzee, a ruptured intracranial aneurysm caused an SAH. Histological descriptions of the aneurysms were strikingly similar to those of humans.

CONCLUSIONS

Although interesting and innovative, the concept of "comparative medicine" seems to be impracticable due to the seemingly ultralow incidence of natural aneurysmal SAH in mammals other than man. The answer to the question "why intracranial aneurysms are less common in animals despite the strong histological similarity of cerebral arteries" might be a key issue. Last but not least, primates likely matter in SAH-related research, as aneurysmal SAH occurs in primates.

摘要

背景

在蛛网膜下腔出血(SAH)动物模型中显示出显著疗效的概念,在人类动脉瘤性SAH中往往未能改善预后。“比较医学”的概念,即对不同物种进行开放的比较,可能为“构建”动物模型的方法提供一种替代方案。动物自然发生的疾病可能比模型更类似于人类疾病。在这种背景下,就产生了动物是否存在自发性颅内动脉瘤以及它们是否会导致SAH的问题。

方法

进行了系统的文献检索。仅纳入涉及除人类以外哺乳动物的自然动脉瘤和/或SAH的文章。所有涉及诱导性动脉瘤和/或SAH的文章均被排除。

结果

在筛选的2812篇文章中,发现了9篇描述自然颅内动脉瘤和/或SAH的文章。总共检查了29个物种的1979只个体动物。在6个物种的7只个体动物中描述了自然颅内动脉瘤。在3个物种中描述了自发性SAH。在1只黑猩猩中,颅内动脉瘤破裂导致了SAH。动脉瘤的组织学描述与人类的惊人相似。

结论

尽管“比较医学”的概念有趣且创新,但由于除人类以外的哺乳动物中自然动脉瘤性SAH的发生率似乎极低,该概念似乎不切实际。“尽管脑动脉在组织学上有很强的相似性,但为什么颅内动脉瘤在动物中较少见”这个问题的答案可能是一个关键问题。最后但同样重要的是,灵长类动物在SAH相关研究中可能很重要,因为动脉瘤性SAH发生在灵长类动物中。

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