Chang Jason J, Armonda Rocco, Goyal Nitin, Arthur Adam S
Department of Critical Care Medicine, MedStar Washington Hospital Center; Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA.
Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA.
Neural Regen Res. 2019 Jul;14(7):1116-1121. doi: 10.4103/1673-5374.251189.
Intracerebral hemorrhage (ICH) remains the second-most common form of stroke with high morbidity and mortality. ICH can be divided into two pathophysiological stages: an acute primary phase, including hematoma volume expansion, and a subacute secondary phase consisting of blood-brain barrier disruption and perihematomal edema expansion. To date, all major trials for ICH have targeted the primary phase with therapies designed to reduce hematoma expansion through blood pressure control, surgical evacuation, and hemostasis. However, none of these trials has resulted in improved clinical outcomes. Magnesium is a ubiquitous element that also plays roles in vasodilation, hemostasis, and blood-brain barrier preservation. Animal models have highlighted potential therapeutic roles for magnesium in neurological diseases specifically targeting these pathophysiological mechanisms. Retrospective studies have also demonstrated inverse associations between admission magnesium levels and hematoma volume, hematoma expansion, and clinical outcome in patients with ICH. These associations, coupled with the multifactorial role of magnesium that targets both primary and secondary phases of ICH, suggest that magnesium may be a viable target of study in future ICH studies.
脑出血（ICH）仍然是第二常见的中风形式，具有高发病率和死亡率。脑出血可分为两个病理生理阶段：急性初级阶段，包括血肿体积扩大；亚急性次级阶段，包括血脑屏障破坏和血肿周围水肿扩大。迄今为止，所有针对脑出血的主要试验都以初级阶段为目标，采用旨在通过控制血压、手术清除血肿和止血来减少血肿扩大的治疗方法。然而，这些试验均未带来改善的临床结果。镁是一种普遍存在的元素，在血管舒张、止血和血脑屏障保护中也发挥作用。动物模型突出了镁在神经疾病中针对这些病理生理机制的潜在治疗作用。回顾性研究还表明，脑出血患者入院时的镁水平与血肿体积、血肿扩大和临床结果之间存在负相关。这些关联，再加上镁针对脑出血初级和次级阶段的多因素作用，表明镁可能是未来脑出血研究中一个可行的研究靶点。
