Spencer Pierce, Jiang Yinghua, Liu Ning, Han Jinrui, Li Yadan, Vodovoz Samuel, Dumont Aaron S, Wang Xiaoying
Clinical Neuroscience Research Center, Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
J Clin Med. 2020 Dec 30;10(1):100. doi: 10.3390/jcm10010100.
Cerebral metabolic dysfunction has been shown to extensively mediate the pathophysiology of brain injury after subarachnoid hemorrhage (SAH). The characterization of the alterations of metabolites in the brain can help elucidate pathophysiological changes occurring throughout SAH and the relationship between secondary brain injury and cerebral energy dysfunction after SAH. Cerebral microdialysis (CMD) is a tool that can measure concentrations of multiple bioenergetics metabolites in brain interstitial fluid. This review aims to provide an update on the implication of CMD on the measurement of metabolic dysfunction in the brain after SAH. A literature review was conducted through a general PubMed search with the terms "Subarachnoid Hemorrhage AND Microdialysis" as well as a more targeted search using MeSh with the search terms "Subarachnoid hemorrhage AND Microdialysis AND Metabolism." Both experimental and clinical papers were reviewed. CMD is a suitable tool that has been used for monitoring cerebral metabolic changes in various types of brain injury. Clinically, CMD data have shown the dramatic changes in cerebral metabolism after SAH, including glucose depletion, enhanced glycolysis, and suppressed oxidative phosphorylation. Experimental studies using CMD have demonstrated a similar pattern of cerebral metabolic dysfunction after SAH. The combination of CMD and other monitoring tools has also shown value in further dissecting and distinguishing alterations in different metabolic pathways after brain injury. Despite the lack of a standard procedure as well as the presence of limitations regarding CMD application and data interpretation for both clinical and experimental studies, emerging investigations have suggested that CMD is an effective way to monitor the changes of cerebral metabolic dysfunction after SAH in real-time, and alternatively, the combination of CMD and other monitoring tools might be able to further understand the relationship between cerebral metabolic dysfunction and brain injury after SAH, determine the severity of brain injury and predict the pathological progression and outcomes after SAH. More translational preclinical investigations and clinical validation may help to optimize CMD as a powerful tool in critical care and personalized medicine for patients with SAH.
脑代谢功能障碍已被证明广泛介导蛛网膜下腔出血（SAH）后脑损伤的病理生理学。大脑中代谢物变化的特征有助于阐明SAH全过程中发生的病理生理变化，以及SAH后继发性脑损伤与脑能量功能障碍之间的关系。脑微透析（CMD）是一种可测量脑间质液中多种生物能量代谢物浓度的工具。本综述旨在更新CMD在SAH后脑代谢功能障碍测量方面的应用情况。通过在PubMed上使用“蛛网膜下腔出血 AND 微透析”进行常规检索，并使用医学主题词（MeSh）以“蛛网膜下腔出血 AND 微透析 AND 代谢”进行更有针对性的检索，对文献进行了综述。实验性和临床研究论文均在审查范围内。CMD是一种适用于监测各种类型脑损伤后脑代谢变化的工具。临床上，CMD数据显示SAH后脑代谢发生了显著变化，包括葡萄糖耗竭、糖酵解增强和氧化磷酸化受抑制。使用CMD的实验研究也证明了SAH后脑代谢功能障碍的类似模式。CMD与其他监测工具的联合使用在进一步剖析和区分脑损伤后不同代谢途径的变化方面也显示出价值。尽管缺乏标准程序，且临床和实验研究在CMD应用及数据解读方面存在局限性，但新出现的研究表明，CMD是实时监测SAH后脑代谢功能障碍变化的有效方法，或者说，CMD与其他监测工具的联合使用可能有助于进一步了解SAH后脑代谢功能障碍与脑损伤之间的关系，确定脑损伤的严重程度，并预测SAH后的病理进展和预后。更多的转化性临床前研究和临床验证可能有助于优化CMD，使其成为SAH患者重症监护和个性化医疗中的有力工具。
