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中风的流行病学、病理生理学及当前治疗策略

Epidemiology, Pathophysiology, and Current Treatment Strategies in Stroke.

作者信息

Ahmed Zubair, Chaudhary Fihr, Agrawal Devendra K

机构信息

Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA.

出版信息

Cardiol Cardiovasc Med. 2024;8(4):389-404. doi: 10.26502/fccm.92920399. Epub 2024 Aug 29.

Abstract

Both ischemic and hemorrhagic strokes are critical health issues and the incidence is on the rise. The rapid neurological degeneration that can occur with either type of stroke warrants prompt medical attention. In the article, we critically reviewed the literature examining their incidence, pathophysiology, and present treatment strategies. Clinical trials show conflicting findings, with ischemic strokes accounting for 87% of all strokes. Brain injury following an ischemic stroke results in cell death and necrosis, immune cells being the primary actors in the process of neuroinflammation. In order to develop neuroprotective drugs against ischemic stroke, detailed investigation of glutamate production and metabolism as well as downstream pathways controlled by glutamate receptors provides significant information on the underlying mechanisms. The permeability of the blood-brain barrier and the degradation of glutamine synthase are two potential mechanisms by which peritoneal dialysis accelerates brain-to-blood glutamate clearance and thus reduces glutamate levels in the brain after a stroke. Oxidative stress in an ischemic stroke disturbs the oxidant-antioxidant balance, which is particularly problematic for brain cells that are high in polyunsaturated fatty acids. Because of demographic factors like age, sex, race/ethnicity, and socioeconomic status, the incidence and prevalence of stroke differ across people and regions. For rapid diagnosis and treatment decisions, diagnostic imaging tools such as vascular imaging, CT, and MRI are essential. To aid in the recovery and lessen neurological impairments following a stroke, novel avenues of research are under investigation on neuroprotective medications that target inflammation, oxidative stress, and neuronal death.

摘要

缺血性卒中和出血性卒中都是严重的健康问题,且发病率呈上升趋势。这两种类型的卒中都可能迅速发生神经退变,因此需要及时就医。在本文中,我们对有关其发病率、病理生理学及当前治疗策略的文献进行了批判性综述。临床试验结果相互矛盾,缺血性卒中占所有卒中的87%。缺血性卒中后的脑损伤会导致细胞死亡和坏死,免疫细胞是神经炎症过程中的主要参与者。为了开发针对缺血性卒中的神经保护药物,详细研究谷氨酸的产生和代谢以及谷氨酸受体控制的下游通路,可为潜在机制提供重要信息。血脑屏障的通透性和谷氨酰胺合成酶的降解是腹膜透析加速脑-血谷氨酸清除从而降低卒中后脑内谷氨酸水平的两种潜在机制。缺血性卒中中的氧化应激会破坏氧化还原平衡,这对富含多不饱和脂肪酸的脑细胞来说尤其成问题。由于年龄、性别、种族/民族和社会经济地位等人口统计学因素,卒中的发病率和患病率在不同人群和地区存在差异。对于快速诊断和治疗决策而言,血管成像、CT和MRI等诊断成像工具至关重要。为了促进卒中后的恢复并减轻神经功能障碍,针对炎症、氧化应激和神经元死亡的神经保护药物的新研究途径正在探索中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11a8/11412115/5102f2ef57f3/nihms-2019873-f0001.jpg

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