遠端缺血預處理對腦缺血保護作用的研究進展_《華西醫學》

作者：

余超 ,  劉進

四川大學華西醫院麻醉科（成都，610041）;

關鍵詞：

遠端缺血預處理腦缺血腦保護

DOI：

10.7507/1002-0179.20130096

視頻：

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遠端缺血預處理可以誘導腦缺血耐受形成從而產生腦保護作用，具有很強的臨床應用價值。其可通過機體不太重要的器官的缺血預處理來保護重要器官如腦、心臟、肺、小腸、胃、肝等，其腦保護機制可能與內源性一氧化氮、絲裂原活化蛋白激酶通道、Notch信號、熱應激蛋白70表達、抗氧化作用、抑制神經元凋亡、神經和（或）體液因素等有關。現對遠端缺血預處理對腦缺血保護作用相關機制的研究現狀作一綜述。

引用本文： 余超,劉進. 遠端缺血預處理對腦缺血保護作用的研究進展. 華西醫學, 2013, 28(2): 298-301. doi: 10.7507/1002-0179.20130096 復制

1.	Murry CE, Jennings RB, Reimer KA, et al. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium[J]. Circulation, 1986, 74(5): 1124-1136.
2.	Przyklenk K, Barbara B, Ovize M, et al. Regional ischemic preconditioning protects remote virgin myocardium from subsequence sustained coronary occlusion[J]. Circulation, 1993, 87(3): 893-899.
3.	袁恒杰, 羅瓊, 朱學慧. 無創性延遲肢體缺血預適應對大鼠腦缺血再灌注皮層的保護作用[J]. 中國臨床藥理學與治療學, 2009, 14(2): 144-149.
4.	Hajrasouliha AR, Tavakoli S, Ghasemi M, et al. Endogenous cannabinoids contribute to remote ischemic preconditioning via cannabinoid CB2 receptors in the rat heart[J]. Eur J Pharmacol, 2008, 579(1- 3): 246-252.
5.	Kanoria S, Jalan R, Davies NA, et al. Remote ischemic preconditioning of the hind limb reduces experimental liver warm ischemia reperfusion injury[J]. Br J Surg, 2006, 93(6): 762-768.
6.	Heidbreder M, Naumann A, Tempel K, et al. Remote ischemic preconditioning: the differential role of mitogen activated protein kinase pathways[J]. Cardiovasc Res, 2008, 78(1): 108-115.
7.	Oehmann C, Benz S, Drognitz O, et al. Remote preconditioning reduces microcirculatory disorders in pancreatic ischemia reperfusion injury[J]. Pancreas, 2007, 35(4): e45-e50.
8.	Jan WC, Chen CH, Tsai PS, et al. Limb ischemic preconditioning mitigates lung injury induced by haemorrhagic shock/resuscitation in rats[J]. Resuscitation, 2011, 82(6): 760-766.
9.	Loukogeorgakis SP, Panagiotidou AT, Broadhead MW, et al. Remote ischemic preconditioning provides early and late protection against endothelial ischemia-reperfusion injury in humans: role of the autonomic nervous system[J]. J Am Coll Cardiol, 2005, 46(3): 450-456.
10.	Tropak MB, Shi H, Li J, et al. Potent neuroprotection induced by remote preconditioning in a rat model of neonatal cerebral hypoxic ischemic injury[J]. J Thorac Cardiovasc Surg, 2011, 142(1): 233-235.
11.	Küntscher MV, Kastell T, Altmann J, et al. Acute remote ischemic preconditioning: the role of nitric oxide[J]. Microsurgery, 2002, 22(6): 227-231.
12.	Ren C, Gao X, Steinberg GK, et al. Limb remote preconditioning protects against focal ischemia in rats and contradicts the dogma of therapeutic time windows for preconditioning[J]. Neuroscience, 2008, 151(4): 1099-1103.
13.	Zhao HG, Sun XC, Xian XH, et al. The role of nitric oxide in the neuroprotection of limb ischemic preconditioning in rats[J]. Neurochem Res, 2007, 32(11): 1919-1926.
14.	Sun XC, Li WB, Li QJ, et al. Limb ischemic preconditioning induces brain ischemic tolerance via p38 MAPK[J]. Brain Res, 2006, 1084(1): 165-174.
15.	孫曉彩, 羨曉輝, 李文斌, 等. 肢體缺血預處理通過激活有絲分裂原激活蛋白激酶p38減輕腦缺血導致的大鼠海馬CA1區神經元凋亡和腦水腫[J]. 中國藥理學與毒理學雜志, 2008, 22(5): 321-328.
16.	Sun XC, Xian XH, Li WB, et al. Activation of p38 MAPK participates in brain ischemic tolerance induced by limb ischemic preconditioning by up-regulating HSP 70[J]. Exp Neurol, 2010, 224(3): 347-355.
17.	Jin RL, Li WB, Li QJ, et al. The role of extracellular signal-regulated kinases in the neuroprotection of limb ischemic preconditioning[J]. Neurosci Res, 2006, 55(1): 65-73.
18.	孫曉彩, 羨曉輝, 蔡勁松, 等. 超氧化物岐化酶參與p38 MAPK介導的肢體缺血預處理對大鼠全腦缺血的保護作用[J]. 中國藥理學與毒理學雜志, 2007, 21(6): 455-461.
19.	趙翚, 董海龍, 熊利澤, 等. 線粒體ATP敏感性鉀離子通道參與遠程預處理對大鼠腦保護作用的機制[J]. 第四軍醫大學學報, 2007, 28(18): 1633-1635.
20.	呂文英, 熊利澤, 董海龍, 等. Notch信號在肢體遠程預處理誘導腦保護機制研究[J]. 中華神經外科疾病研究雜志, 2011, 10(3): 214-217.
21.	趙紅崗, 李文斌, 李清君, 等. 肢體缺血預處理對大鼠缺血再灌注海馬HSP70表達的影響[J]. 中風與神經疾病雜志, 2006, 23(1): 93-96.
22.	袁恒杰, 羅瓊, 朱學慧, 等. 無創性延遲肢體缺血預適應對大鼠腦缺血再灌注皮層的保護作用[J]. 中國臨床藥理學與治療學, 2009, 14(2): 144-149.
23.	Yannopoulos FS, Mäkelä T, Niemelä E, et al. Improved cerebral recovery from hypothermic circulatory arrest after remote ischemic preconditioning[J]. Ann Thorac Surg, 2010, 90(1): 182-188.
24.	趙紅崗, 李文斌, 李清君, 等. 肢體缺血預處理減少大鼠全腦缺血再灌注誘導的海馬CA1區錐體神經元凋亡[J]. 生理學報, 2004, 56(3): 143-148.
25.	Dave KR, Saul I, Prado R, et al. Remote organ ischemic preconditioning protect brain from ischemic damage following asphyxial cardiac arrest[J]. Neurosci Lett, 2006, 404(1-2): 170-175.
26.	Saxena P, Bala A, Campbell K, et al. Does remote ischemic preconditioning prevent delayed hippocampal neuronal death following transient global cerebral ischemia in rats?[J]. Perfusion, 2009, 24(3): 207-211.
27.	胡勝, 熊利澤. 遠程缺血預處理研究進展[J]. 上海醫學, 2010, 33(6): 598-601.
28.	Dong HL, Zhang Y, Su BX, et al. Limb remote ischemic preconditioning protects the spinal cord from ischemia-reperfusion injury[J]. Anesthesiology, 2010, 112(4): 881-891.
29.	Shimizu M. Tropak M. Diaz RJ, et al. Transient limb ischaemia remotely preconditions through a humoral mechanism acting directly on the myocardium: evidence suggesting cross-species protection[J]. Clin Sci, 2009, 117(5): 191-200.
30.	Kingma JG Jr, Simard D, Voisine P, et al. Role of the autonomic nervous system in cardioprotection by remote preconditioning in isoflurane anaesthetized dogs[J]. Cardiovasc Res, 2011, 89(2): 384-391.
31.	Tapuria N, Kumar Y, Habib MM, et al. Remote Ischemic preconditioning: a novel protective method from ischemia reperfusion injury--a review[J]. J Surg Res, 2008, 150(2): 304-330.
32.	Bolte CS, Liao S, Gross GJ, et al. Remote preconditioning-endocrine factors in organ protection against ischemic injury[J]. Endocr Metab Immune Disord Drug Targets, 2007, 7(3): 167-175.
33.	趙紅崗, 李文斌, 孫曉彩, 等. 神經途徑在肢體缺血預處理抗腦缺血/再灌注損傷中的作用[J]. 中國應用生理學雜志, 2007, 23(1): 19-23.
34.	Malhotra S, Naggar I, Stewart M, et al. Neurogenic pathway mediated remote preconditioning protects the brain from transient focal ischemic injury[J]. Brain Res, 2011, 1386: 184-190.
35.	Gho BC, Schoemaker RG, van den Doel MA, et al. Myocardial protection by brief ischemia in noncardiac tissue[J]. Circulation, 1996, 94(9): 2193-2200.
36.	Lim SY, Yellon DM, Hausenloy DJ, et al. The neural and humoral pathways in remote limb ischemic preconditioning[J]. Basic Res Cardiol, 2010, 105(5): 651-655.

1. 　Murry CE, Jennings RB, Reimer KA, et al. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium[J]. Circulation, 1986, 74(5): 1124-1136.
2. 　Przyklenk K, Barbara B, Ovize M, et al. Regional ischemic preconditioning protects remote virgin myocardium from subsequence sustained coronary occlusion[J]. Circulation, 1993, 87(3): 893-899.
3. 　袁恒杰, 羅瓊, 朱學慧. 無創性延遲肢體缺血預適應對大鼠腦缺血再灌注皮層的保護作用[J]. 中國臨床藥理學與治療學, 2009, 14(2): 144-149.
4. 　Hajrasouliha AR, Tavakoli S, Ghasemi M, et al. Endogenous cannabinoids contribute to remote ischemic preconditioning via cannabinoid CB2 receptors in the rat heart[J]. Eur J Pharmacol, 2008, 579(1- 3): 246-252.
5. 　Kanoria S, Jalan R, Davies NA, et al. Remote ischemic preconditioning of the hind limb reduces experimental liver warm ischemia reperfusion injury[J]. Br J Surg, 2006, 93(6): 762-768.
6. 　Heidbreder M, Naumann A, Tempel K, et al. Remote ischemic preconditioning: the differential role of mitogen activated protein kinase pathways[J]. Cardiovasc Res, 2008, 78(1): 108-115.
7. 　Oehmann C, Benz S, Drognitz O, et al. Remote preconditioning reduces microcirculatory disorders in pancreatic ischemia reperfusion injury[J]. Pancreas, 2007, 35(4): e45-e50.
8. 　Jan WC, Chen CH, Tsai PS, et al. Limb ischemic preconditioning mitigates lung injury induced by haemorrhagic shock/resuscitation in rats[J]. Resuscitation, 2011, 82(6): 760-766.
9. 　Loukogeorgakis SP, Panagiotidou AT, Broadhead MW, et al. Remote ischemic preconditioning provides early and late protection against endothelial ischemia-reperfusion injury in humans: role of the autonomic nervous system[J]. J Am Coll Cardiol, 2005, 46(3): 450-456.
10. 　Tropak MB, Shi H, Li J, et al. Potent neuroprotection induced by remote preconditioning in a rat model of neonatal cerebral hypoxic ischemic injury[J]. J Thorac Cardiovasc Surg, 2011, 142(1): 233-235.
11. 　Küntscher MV, Kastell T, Altmann J, et al. Acute remote ischemic preconditioning: the role of nitric oxide[J]. Microsurgery, 2002, 22(6): 227-231.
12. 　Ren C, Gao X, Steinberg GK, et al. Limb remote preconditioning protects against focal ischemia in rats and contradicts the dogma of therapeutic time windows for preconditioning[J]. Neuroscience, 2008, 151(4): 1099-1103.
13. 　Zhao HG, Sun XC, Xian XH, et al. The role of nitric oxide in the neuroprotection of limb ischemic preconditioning in rats[J]. Neurochem Res, 2007, 32(11): 1919-1926.
14. 　Sun XC, Li WB, Li QJ, et al. Limb ischemic preconditioning induces brain ischemic tolerance via p38 MAPK[J]. Brain Res, 2006, 1084(1): 165-174.
15. 　孫曉彩, 羨曉輝, 李文斌, 等. 肢體缺血預處理通過激活有絲分裂原激活蛋白激酶p38減輕腦缺血導致的大鼠海馬CA1區神經元凋亡和腦水腫[J]. 中國藥理學與毒理學雜志, 2008, 22(5): 321-328.
16. 　Sun XC, Xian XH, Li WB, et al. Activation of p38 MAPK participates in brain ischemic tolerance induced by limb ischemic preconditioning by up-regulating HSP 70[J]. Exp Neurol, 2010, 224(3): 347-355.
17. 　Jin RL, Li WB, Li QJ, et al. The role of extracellular signal-regulated kinases in the neuroprotection of limb ischemic preconditioning[J]. Neurosci Res, 2006, 55(1): 65-73.
18. 　孫曉彩, 羨曉輝, 蔡勁松, 等. 超氧化物岐化酶參與p38 MAPK介導的肢體缺血預處理對大鼠全腦缺血的保護作用[J]. 中國藥理學與毒理學雜志, 2007, 21(6): 455-461.
19. 　趙翚, 董海龍, 熊利澤, 等. 線粒體ATP敏感性鉀離子通道參與遠程預處理對大鼠腦保護作用的機制[J]. 第四軍醫大學學報, 2007, 28(18): 1633-1635.
20. 　呂文英, 熊利澤, 董海龍, 等. Notch信號在肢體遠程預處理誘導腦保護機制研究[J]. 中華神經外科疾病研究雜志, 2011, 10(3): 214-217.
21. 　趙紅崗, 李文斌, 李清君, 等. 肢體缺血預處理對大鼠缺血再灌注海馬HSP70表達的影響[J]. 中風與神經疾病雜志, 2006, 23(1): 93-96.
22. 　袁恒杰, 羅瓊, 朱學慧, 等. 無創性延遲肢體缺血預適應對大鼠腦缺血再灌注皮層的保護作用[J]. 中國臨床藥理學與治療學, 2009, 14(2): 144-149.
23. 　Yannopoulos FS, Mäkelä T, Niemelä E, et al. Improved cerebral recovery from hypothermic circulatory arrest after remote ischemic preconditioning[J]. Ann Thorac Surg, 2010, 90(1): 182-188.
24. 　趙紅崗, 李文斌, 李清君, 等. 肢體缺血預處理減少大鼠全腦缺血再灌注誘導的海馬CA1區錐體神經元凋亡[J]. 生理學報, 2004, 56(3): 143-148.
25. 　Dave KR, Saul I, Prado R, et al. Remote organ ischemic preconditioning protect brain from ischemic damage following asphyxial cardiac arrest[J]. Neurosci Lett, 2006, 404(1-2): 170-175.
26. 　Saxena P, Bala A, Campbell K, et al. Does remote ischemic preconditioning prevent delayed hippocampal neuronal death following transient global cerebral ischemia in rats?[J]. Perfusion, 2009, 24(3): 207-211.
27. 　胡勝, 熊利澤. 遠程缺血預處理研究進展[J]. 上海醫學, 2010, 33(6): 598-601.
28. 　Dong HL, Zhang Y, Su BX, et al. Limb remote ischemic preconditioning protects the spinal cord from ischemia-reperfusion injury[J]. Anesthesiology, 2010, 112(4): 881-891.
29. 　Shimizu M. Tropak M. Diaz RJ, et al. Transient limb ischaemia remotely preconditions through a humoral mechanism acting directly on the myocardium: evidence suggesting cross-species protection[J]. Clin Sci, 2009, 117(5): 191-200.
30. 　Kingma JG Jr, Simard D, Voisine P, et al. Role of the autonomic nervous system in cardioprotection by remote preconditioning in isoflurane anaesthetized dogs[J]. Cardiovasc Res, 2011, 89(2): 384-391.
31. 　Tapuria N, Kumar Y, Habib MM, et al. Remote Ischemic preconditioning: a novel protective method from ischemia reperfusion injury--a review[J]. J Surg Res, 2008, 150(2): 304-330.
32. 　Bolte CS, Liao S, Gross GJ, et al. Remote preconditioning-endocrine factors in organ protection against ischemic injury[J]. Endocr Metab Immune Disord Drug Targets, 2007, 7(3): 167-175.
33. 　趙紅崗, 李文斌, 孫曉彩, 等. 神經途徑在肢體缺血預處理抗腦缺血/再灌注損傷中的作用[J]. 中國應用生理學雜志, 2007, 23(1): 19-23.
34. 　Malhotra S, Naggar I, Stewart M, et al. Neurogenic pathway mediated remote preconditioning protects the brain from transient focal ischemic injury[J]. Brain Res, 2011, 1386: 184-190.
35. 　Gho BC, Schoemaker RG, van den Doel MA, et al. Myocardial protection by brief ischemia in noncardiac tissue[J]. Circulation, 1996, 94(9): 2193-2200.
36. 　Lim SY, Yellon DM, Hausenloy DJ, et al. The neural and humoral pathways in remote limb ischemic preconditioning[J]. Basic Res Cardiol, 2010, 105(5): 651-655.

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遠端缺血預處理對腦缺血保護作用的研究進展

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《華西醫學》

遠端缺血預處理對腦缺血保護作用的研究進展

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