切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 322 -326. doi: 10.11817/j.issn.1673-9248.2020.06.002

所属专题: 专家论坛 文献

专家论坛

妊娠相关脑血管病的研究进展
吴雅婷1, 彭斌1,()   
  1. 1. 100730 中国医学科学院北京协和医院神经科
  • 收稿日期:2020-03-24 出版日期:2020-12-01
  • 通信作者: 彭斌

Research progress of pregnancy-related cerebrovascular diseases

Yating Wu1, Bin Peng1()   

  1. 1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2020-03-24 Published:2020-12-01
  • Corresponding author: Bin Peng
  • About author:
    Corresponding author: Peng Bin, Email:
引用本文:

吴雅婷, 彭斌. 妊娠相关脑血管病的研究进展[J]. 中华脑血管病杂志(电子版), 2020, 14(06): 322-326.

Yating Wu, Bin Peng. Research progress of pregnancy-related cerebrovascular diseases[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2020, 14(06): 322-326.

脑血管病是妊娠期间常见的神经系统并发症之一,妊娠相关的血流动力学变化以及体内高凝状态等因素均可增加脑血管病变的风险。而妊娠相关的脑血管病预后常较差,病死率较高,并且影响母体围产期和胎儿健康,因此需要早期识别和治疗。本文通过复习妊娠期及产褥期发生的缺血性卒中、出血性卒中、后部可逆性脑病综合征及可逆性脑血管收缩综合征的流行病学、病理生理改变、临床表现、诊断、治疗和预后,以期加强临床上对孕产妇脑血管病变的预防、识别和治疗,从而降低妊娠相关脑血管病的发病率和病死率。

Cerebrovascular disease is one of the most common neurological complications during pregnancy. Pregnancy-related hemodynamic changes, hypercoagulable state and other factors could increase the risk of cerebrovascular disease. Pregnancy-related cerebrovascular diseases often lead to poor prognosis and high mortality, and could affect the health of the fetus/fetuses. Therefore, early recognition and treatment is necessary. In this review, we discusses the epidemiology, pathophysiological changes, clinical manifestations, treatment, and prognosis of ischemic stroke, hemorrhagic stroke, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome during pregnancy and postpartum period. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reduce the morbidity and mortality of pregnancy-related cerebrovascular diseases.

1
Yoshida K, Takahashi JC, Takenobu Y, et al. Strokes associated with pregnancy and puerperium: A nationwide study by the Japan stroke society [J]. Stroke, 2017, 48(2): 276-282.
2
Bushnell C, Mccullough L. Stroke prevention in women: synopsis of the 2014 American Heart Association/American Stroke Association guideline [J]. Ann Intern Med, 2014, 160(12): 853-857.

URL    
3
Liang CC, Chang SD, Lai SL, et al. Stroke complicating pregnancy and the puerperium [J]. Eur J Neurol, 2006, 13(11): 1256-1260.
4
Bushnell C, McCullough LD, Awad IA, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2014, 45(5): 1545-1588.
5
Cerneca F, Ricci G, Simeone R, et al. Coagulation and fibrinolysis changes in normal pregnancy. Increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis [J]. Eur J Obstet Gynecol Reprod Biol, 1997, 73(1): 31-36.
6
AmaraI LM, Cunningham MW, Cornelius DC, et a1. Preeclampsia:long—term consequences for vascular health [J]. Vasc Health Risk Manag, 2015, 11(6): 403-415.
7
McDermott M, Miller EC, Rundek T, et al. Preeclampsia: Association with posterior reversible encephalopathy syndrome and stroke [J]. Stroke, 2018, 49(3): 524-530.
8
Sanders BD, Davis MG, Holley SL, et al. Pregnancy-associated stroke [J]. J Midwifery Womens Health, 2018, 63(1): 23-32.
9
Zambrano MD, Miller EC. Maternal Stroke: An Update [J]. Curr Atheroscler Rep, 2019, 21(9): 33.
10
Lin SY, Hu CJ, Lin HC. Increased risk of stroke in patients who undergo cesarean delivery: a nationwide population-based study [J]. Am J Obstet Gynecol, 2008, 198(4): 391-397.
11
Miller EC, Yaghi S, Boehme AK, et al. Mechanisms and outcomes of stroke during pregnancy and the postpartum period: a cross-sectional study [J]. Neurol Clin Pract, 2016, 6(1): 29-39.
12
Kupferminc MJ, Yair D, Bornstein NM, et al. Transient focal neurological deficits during pregnancy in carriers of inherited thrombophilia [J]. Stroke, 2000, 31(4): 892-895.
13
James AH, Bushnell CD, Jamison MG, et al. Incidence and risk factors for stroke in pregnancy and the puerperium [J]. Obstet Gynecol, 2005, 106(3): 509-516.
14
Ogilvy CS, Stieg PE, Awad I, et al. AHA Scientific Statement: recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association [J]. Stroke, 2001, 32(6): 1458-1471.
15
Bateman BT, Schumacher HC, Bushnell CD, et al. Intracerebral hemorrhage in pregnancy. Frequency, risk factors, and outcome [J]. Neurology, 2006, 67(3): 424-429.
16
Grear KE, Bushnell CD. Stroke and pregnancy: clinical presentation, evaluation, treatment and epidemiology [J]. Clin Obstet Gynecol, 2013, 56(2): 350-359.

URL    
17
Jeng JS, Tang SC, Yip PK. Incidence and etiologies of stroke during pregnancy and puerperium as evidenced in Taiwanese women [J]. Cerebrovasc Dis, 2004, 18(4): 290-295.
18
Skidmore FM, Williams LS, Fradkin KD, et al. Presentation, etiology, and outcome of stroke in pregnancy and puerperium [J]. J Stroke Cerebrovasc Dis, 2001, 10(1): 1-10.
19
Alsheikh-Ali AA, Thaler DE, Kent DM. Patent foramen ovale in cryptogenic stroke: incidental or pathogenic [J]. Stroke, 2009, 40(7): 2349-2355.
20
Beroyz G, Casale R, Farreiros A, et al. CLASP-A randomized trial of low-dose aspirin for the prevention and treatment of preeclampsia among 9364 pregnant-women [J]. Lancet, 1994, 343(8898): 619-629.
21
Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the american heart association/ american stroke association [J]. Stroke, 2016, 47(2): 581-641.
22
Leffert LR, Clancy CR, Bateman BT, et al. Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period [J]. Am J Obstet Gynecol, 2016, 214(6): 721-723.
23
Kular S, Ram R, Balian V, et al. Mechanical thrombectomy for acute stroke in pregnancy [J]. Neuroradiol J, 2020, 33(2): 134-139.
24
Ladhani NNN, Swartz RH, Foley N, et al. Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy [J]. Int J Stroke, 2018, 13(7): 743-758.
25
Bousser MG, Crassard I. Cerebral venous thrombosis, pregnancy and oral contraceptives [J]. Thromb Res, 2012, 130(Suppl 1): S19-S22.

URL    
26
Saposnik G, Barinagarrementeria F, Brown R, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2011, 42(4):1158-1192.

URL    
27
Liang ZW, Gao WL, Feng LM. Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium [J]. Sci Rep, 2017, 7(6): 43866.
28
Ferro JM, Aguiar de Sousa D. Cerebral Venous Thrombosis: an Update [J]. Curr Neurol Neurosci Rep, 2019, 19(10): 74.
29
Coutinho JM, Ferro JM, Canhão P, et al. Cerebral venous and sinus thrombosis in women [J]. Stroke, 2009, 40(7): 2356-2361.
30
Del Zotto E, Giossi A, Volonghi I, et al. Ischemic stroke during pregnancy and puerperium [J]. Stroke Res Treat, 2011, 2011(1): 606780.
31
Aguiar de Sousa D, Canhão P, Crassard I, et al. Safety of pregnancy after cerebral venous thrombosis results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 PREGNANCY study [J]. Stroke, 2017, 48(11): 3130-313.
32
Sousa DAD, Canhao P, Ferro JM, et al. Safety of pregnancy after cerebral venous thrombosis--A systematic review [J]. Stroke, 2017, 47(3): 713-718.
33
Rottenstreich A, Gershgoren H, Spectre G, et al. Factors associated with pregnancy outcomes in women with a history of cerebral sinus venous thrombosis [J]. J Thromb Thrombolysis, 2019. Online ahead of print.
34
Sharshar T, Lamy C, Mas JL. Stroke in pregnancy study group. Incidence and causes of stroke associated with pregnancy and puerperium: a study in public hospitals of Ile de France [J]. Stroke, 1995, 26(6): 930-936.
35
Kittner SJ, Stern BJ, Feeser BR, et al. Pregnancy and the risk of stroke [J]. N Engl J Med, 1996, 335(7): 768-774.
36
Ascanio LC, Maragkos GA, Young BC, et al. Spontaneous Intracranial Hemorrhage in Pregnancy: A Systematic Review of the Literature [J]. Neurocrit Care, 2019, 30(1): 5-15.
37
Lumbers ER, Stevens AD. Changes in fetal renal function in response to infusions of a hyperosmotic solution of mannitol to the ewe [J]. J Physiol, 1983, 343(10): 439-446.
38
Burgess AM, Vere DW. Teratogenic effects of some calcium channel blocking agents in Xenopus embryos [J]. Pharmacol Toxicol, 1989, 64(1): 78-82.
39
Euser AG, Cipolla MJ. Magnesium sulfate for the treatment of eclampsia: a brief review [J]. Stroke, 2009, 40(4): 1169-1175.
40
Dias MS, Sekhar LN. Intracranial hemorrhage from aneurysms and Arteriovenous malformations during pregnancy and the puerperium [J]. Neurosurgery, 1990, 27(6): 855-865.
41
Trivedi RA, Kirkoatriek PJ. Arteriovenous malformations of the cerebral circulation that rupttmre in pregnancy [J]. J Obstet Gynaecol, 2003, 23(5): 484-489.
42
Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome [J]. N Engl J Med, 1996, 334(8): 494-500.
43
Postma IR, Slager S, Kremer HP, et al. Long-term consequences of the posterior reversible encephalopathy syndrome in eclampsia and preeclampsia: a review of the obstetric and nonobstetric literature [J]. Obstet Gynecol Surv, 2014, 69(5): 287-300.

URL    
44
Uwatoko T, Toyoda K, Hirai Y, et al. Reversible posterior leukoencephalopathy syndrome in a postpartum woman without eclampsia [J]. Intern Med, 2003, 42(11): 1139-1143.
45
Davie CA, Brim P. Stoke and pregnancy [J]. J Neurol Neurosurg Psychiatry, 2008, 79(3):240-5.
46
Roth C, Ferbert A. Posterior reversible encephalopathy syndrome: is there a difference between pregnant and non-pregnant patients? [J]. Eur Neurol, 2009, 62(3): 142-148.
47
Wolff V, Ducros A. Reversible cerebral vasoconstriction syndrome without typical thunderclap headache [J]. Headache, 2016, 56(4): 674-687.
48
Ducros A. Reversible cerebral vasoconstriction syndrome [J]. Lancet Neurol, 2012, 11(10): 906-917.

URL    
49
Tanaka K, Matsushima M, Matsuzawa Y, et al. Antepartum reversible cerebral vasoconstriction syndrome with pre-eclampsia and reversible posterior leukoencephalopathy [J]. J Obstet Gynaecol Res, 2015, 41(11): 1843-1847.
50
Mijalski C, Dakay K, Miller-Patterson C, et al. Magnesium for treatment of reversible cerebral vasoconstriction syndrome: case series [J]. Neurohospitalist, 2016, 6(3): 111-113.
[1] 王丽, 武玺宁, 王凤兰, 孝梦甦, 刘赫, 朱庆莉, 李建初, 姜玉新. 妊娠哺乳期乳腺疾病超声诊断质量分析[J]. 中华医学超声杂志(电子版), 2022, 19(11): 1269-1273.
[2] 胡金科, 钟文. 妊娠期输尿管结石的处理与转归[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 377-381.
[3] 任国华, 杜晓晓, 洪善玲, 邵帅. 妊娠期高血压并发急性肾损伤患者血清白细胞介素-22、硫化氢及护骨素水平的变化与意义[J]. 中华肾病研究电子杂志, 2023, 12(03): 150-155.
[4] 陈科春, 吴秋义, 李建, 周寅, 徐周. 基于不同中性粒细胞与淋巴细胞比值探讨机械取栓术后首次CT征象与患者预后的关系[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 215-221.
[5] 朱建华, 刘茜茜, 郑玉琳, 朱水兵. 脑循环治疗仪联合综合康复训练对急性缺血性脑卒中恢复期的效果观察[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(06): 349-354.
[6] 韩道旭, 王勉, 王艺璇, 韩晓云, 李春晓. 妊娠期高血压疾病患者血清Ca2+、25-羟维生素D、D-二聚体水平变化及临床意义[J]. 中华临床医师杂志(电子版), 2023, 17(01): 43-47.
[7] 陈青, 吴克瑾. 《中国妊娠期与哺乳期乳腺癌临床实践指南(2022版)》基本问题解读[J]. 中华临床医师杂志(电子版), 2022, 16(11): 1050-1053.
[8] 赵守法, 王舒, Larissa Miare Vados, Alberto Cantidio Ferreira. 醒脑开窍针刺法结合康复疗法治疗缺血性中风病恢复期的疗效观察[J]. 中华针灸电子杂志, 2023, 12(04): 151-155.
[9] 金泽平, 董晶, 柳云鹏, 汪阳. 菌群-肠道-脑轴与缺血性卒中危险因素关系的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 510-517.
[10] 尹琛俊, 张喆, 李晓明. 卵圆孔未闭相关血栓形成机制的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 307-311.
[11] 袁兴运, 陈万红, 鱼丽萍, 姚力. 以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 394-399.
[12] 邱令智, 胡萍, 罗婷, 鄢华. 脂蛋白(a)与心房颤动关系的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(03): 280-284.
[13] 张运, 裴月红, 傅瑜. 急性缺血性卒中静脉溶栓治疗进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 83-88.
[14] 林雨, 王艳玲. 颈动脉斑块易损性的评估与干预的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(01): 66-69.
[15] 白艳, 董秋梅, 王雄耀. 颈动脉粥样硬化性缺血性卒中风险评估的研究进展[J]. 中华脑血管病杂志(电子版), 2022, 16(06): 439-442.
阅读次数
全文


摘要