Ildan F, Polat S, Oner A, Isbir T, Cetinalp E, Kaya M, Karadayi A
Department of Neurosurgery, Cukurova University, School of Medicine, Balcali Adana, Turkey.
Surg Neurol. 1995 Dec;44(6):573-80. doi: 10.1016/0090-3019(95)00219-7.
Although use of corticosteroid in the management of head trauma has caused a great deal of controversy, corticosteroids have long been an adjunct in the management of severe closed head injury. The glucocorticoid steroid methylprednisolone (MP) has been proven to have significant antioxidant effect when administered in an antioxidant-high dose after central nervous system injury.
The sodium-potassium activated and magnesium dependent adenosine-5'-triphosphatase (Na(+)-K(+)/Mg(+2) ATPase EC.3.6.1.3.) activity, lipid peroxidation, and early ultrastructural findings were determined during the immediate posttraumatic period in rats. Mechanical brain injury was produced when a calibrated weight-drop device is allowed to fall on the skull's convexity over the right hemisphere, 1 to 2 mm lateral from the midline. In group I, rats were used to determine Na(+)-K(+)/Mg(+2) ATPase activity, the extent of lipid peroxidation, by measuring the level of malondialdehyde content and normal ultrastructural findings in two different brain areas (cerebral cortex and brain stem). In group II, physiologic saline was administered right after trauma in the same amount as methylprednisolone. In group III rats, methylprednisolone (30 mg/kg) was administered intravenously right after trauma.
Na(+)-K(+)/Mg(+2) ATPase activity significantly decreased in the cerebral cortex and in brain stem within 2 hours after trauma (p < 0.05). There was significant difference in malondialdehyde content between groups II and III (p < 0.05). Methylprednisolone treatment reduced malondialdehyde content and induced the recovery of Na(+)-K(+)/Mg(+2) activity.
These data suggest that inactivation of Na(+)-K(+)/Mg(+2) ATPase is closely correlated to changes of lipid peroxidation and the alteration of the ultrastructural findings in the early phases after head trauma. The glucocorticoid steroid methylprednisolone has been proven to have significant effect in activation of Na(+)-K(+)/Mg(+2) ATPase with significant reduction of malondialdehyde content.
尽管在头部创伤管理中使用皮质类固醇引起了诸多争议，但长期以来皮质类固醇一直是严重闭合性颅脑损伤管理中的辅助药物。糖皮质激素甲泼尼龙（MP）已被证明在中枢神经系统损伤后以高抗氧化剂量给药时具有显著的抗氧化作用。
在大鼠创伤后即刻期间测定钠钾激活且依赖镁的腺苷 - 5'-三磷酸酶（Na(+)-K(+)/Mg(+2) ATPase EC.3.6.1.3.）活性、脂质过氧化以及早期超微结构变化。当校准的重物下落装置落在右半球颅骨凸面、距中线外侧1至2毫米处时造成机械性脑损伤。在第一组中，使用大鼠通过测量丙二醛含量水平来确定Na(+)-K(+)/Mg(+2) ATPase活性、脂质过氧化程度以及两个不同脑区（大脑皮层和脑干）的正常超微结构变化。在第二组中，创伤后立即给予与甲泼尼龙相同量的生理盐水。在第三组大鼠中，创伤后立即静脉注射甲泼尼龙（30毫克/千克）。
创伤后2小时内大脑皮层和脑干中的Na(+)-K(+)/Mg(+2) ATPase活性显著降低（p < 0.05）。第二组和第三组之间丙二醛含量存在显著差异（p < 0.05）。甲泼尼龙治疗降低了丙二醛含量并促使Na(+)-K(+)/Mg(+2)活性恢复。
这些数据表明，头部创伤后早期，Na(+)-K(+)/Mg(+2) ATPase失活与脂质过氧化变化及超微结构变化密切相关。糖皮质激素甲泼尼龙已被证明在激活Na(+)-K(+)/Mg(+2) ATPase并显著降低丙二醛含量方面具有显著作用。
