Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
J Cereb Blood Flow Metab. 2023 Aug;43(8):1237-1253. doi: 10.1177/0271678X231171991. Epub 2023 May 3.
The loss of cerebral autoregulation (CA) is a common and detrimental secondary injury mechanism following acute brain injury and has been associated with worse morbidity and mortality. However patient outcomes have not as yet been conclusively proven to have improved as a result of CA-directed therapy. While CA monitoring has been used to modify CPP targets, this approach cannot work if the impairment of CA is not simply related to CPP but involves other underlying mechanisms and triggers, which at present are largely unknown. Neuroinflammation, particularly inflammation affecting the cerebral vasculature, is an important cascade that occurs following acute injury. We hypothesise that disturbances to the cerebral vasculature can affect the regulation of CBF, and hence the vascular inflammatory pathways could be a putative mechanism that causes CA dysfunction. This review provides a brief overview of CA, and its impairment following brain injury. We discuss candidate vascular and endothelial markers and what is known about their link to disturbance of the CBF and autoregulation. We focus on human traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH), with supporting evidence from animal work and applicability to wider neurologic diseases.
脑自动调节（CA）的丧失是急性脑损伤后的一种常见且有害的继发性损伤机制，与更高的发病率和死亡率相关。然而，迄今为止，尚未有明确的证据表明 CA 靶向治疗会改善患者的预后。虽然 CA 监测已被用于调整 CPP 目标，但如果 CA 的损害不仅仅与 CPP 相关，而是涉及其他潜在机制和触发因素，而目前这些因素在很大程度上尚不清楚，那么这种方法就行不通了。神经炎症，特别是影响脑血管的炎症，是急性损伤后发生的一个重要级联反应。我们假设脑血管的紊乱会影响 CBF 的调节，因此血管炎症途径可能是导致 CA 功能障碍的一个潜在机制。这篇综述简要概述了 CA 及其在脑损伤后的损伤。我们讨论了候选的血管和内皮标志物，以及它们与 CBF 和自动调节紊乱之间的联系。我们重点关注人类创伤性脑损伤（TBI）和蛛网膜下腔出血（SAH），并提供了来自动物研究的支持证据以及对更广泛的神经疾病的适用性。
