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脑出血后延迟性水肿使用地塞米松:用还是不用?

Dexamethasone for delayed edema after intracerebral hemorrhage: To be or not to be?

作者信息

Ye Yongqing, Xu Jin, Han Yuhan

机构信息

Department of Neurosurgery, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu Province, Suqian 223800, China.

Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150000, China.

出版信息

Heliyon. 2023 Jun 28;9(7):e17621. doi: 10.1016/j.heliyon.2023.e17621. eCollection 2023 Jul.

Abstract

The pathogenesis of delayed cerebral edema after intracerebral hemorrhage is still unclear. In this case report, we speculate that the formation of subdural effusion or hemorrhage is associated with delayed cerebral edema. By referring to the treatment plan of chronic subdural hematoma, adding dexamethasone to routine medication, certain therapeutic effect has been achieved. Dexamethasone may maintain the stability of blood-brain barrier by directly increasing the expression of ZO-1, and reduce the neuroinflammatory response caused by NF-κB pathway by upregulating KLF2 expression, ultimately reducing nerve injury through multiple pathways.

摘要

脑出血后迟发性脑水肿的发病机制仍不清楚。在本病例报告中,我们推测硬膜下积液或出血的形成与迟发性脑水肿有关。参照慢性硬膜下血肿的治疗方案,在常规用药中加用地塞米松,取得了一定的治疗效果。地塞米松可能通过直接增加紧密连接蛋白1(ZO-1)的表达来维持血脑屏障的稳定性,并通过上调 Kruppel样因子2(KLF2)的表达来减轻核因子κB(NF-κB)通路引起的神经炎症反应,最终通过多种途径减轻神经损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52e0/10395021/a621e642cce0/gr1.jpg

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