脑梗死后恶性脑水肿预测因素的研究进展

doi:10.11817/j.issn.1673-9248.2023.02.014

恶性脑水肿是指大面积脑梗死后发生严重占位效应的脑水肿，且导致神经功能进行性恶化，并可能因此进展为脑疝甚至死亡的恶性状态。恶性脑水肿是导致患者预后不良甚至死亡的主要原因。早期预测并及时干预恶性脑水肿临床意义重大。目前，寻找能够预测恶性脑水肿发生指标已成为研究的重点和热点。本文围绕近年来预测恶性脑水肿发生的研究进展，从临床评分、影像学指标和生化标志物等方面进行综述，旨在为恶性脑水肿防治提供理论依据。

关键词: 恶性脑水肿, 大面积脑梗死, 预测因素

Malignant cerebral edema is a status with severe space-occupying effect after massive cerebral infarction, which leads to progressive deterioration of neurological function and may progress to cerebral hernia or even the death. Malignant cerebral edema is the leading cause of poor prognosis and even deaths of patients with strokes. Therefore, early prediction and timely intervention of malignant cerebral edema are clinically significant. At present, it has become the focus and hotspot of research to find the indicators that can predict the occurrence of malignant cerebral edema. This article reviews the progress of recent studies of malignant cerebral edema from the aspects of imaging indicators, clinical scores, and biochemical markers in order to provide a theoretical basis for reducing the occurrence of malignant cerebral edema.

Key words: Malignant cerebral edema, Massive cerebral infarction, Predictive factors

1	Huttner HB, Schwab S. Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives [J]. Lancet Neurol, 2009, 8(10): 949-958.
2	Miao JF, Song XY, Sun WZ, et al. Predictors of malignant cerebral edema in cerebral artery infarction: A meta-analysis [J]. J Neurol Sci, 2020, 409: 116607.
3	Fuhrer H, Schonenberger S, Niesen WD, et al. Endovascular stroke treatment's impact on malignant type of edema (ESTIMATE) [J]. J Neurol, 2019, 266(1): 223-231.
4	Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves: An ultrasound study of the optic nerve sheath [J]. Surg Radiol Anat, 1996, 18(4): 323-328.
5	Lochner P, Fassbender K, Andrejewski A, et al. Sonography of optic nerve sheath diameter identifies patients with middle cerebral artery infarction at risk of a malignant course: a pilot prospective observational study [J]. J Neurol, 2020, 267(9): 2713-2720.
6	Vaiman M, Gottlieb P, Bekerman I. Quantitative relations between the eyeball, the optic nerve, and the optic canal important for intracranial pressure monitoring [J]. Head Face Med, 2014, 10: 32.
7	Albert AF, Kirkman MA. Clinical and radiological predictors of malignant middle cerebral artery infarction development and outcomes [J]. J Stroke Cerebrovasc Dis, 2017, 26(11): 2671-2679.
8	Legros V, Lefour S, Bard M, et al. Optic nerve and perioptic sheath diameter (ONSD), eyeball transverse diameter (ETD) and ONSD/ETD ratio on MRI in large middle cerebral artery infarcts: a case-control study [J]. J Stroke Cerebrovasc Dis, 2021, 30(3): 105500.
9	Lee SJ, Choi MH, Lee SE, et al. Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study [J]. BMC Neurol, 2020, 20(1): 354.
10	Broocks G, Flottmann F, Ernst M, et al. Computed tomography-based imaging of Voxel-Wise lesion water uptake in ischemic brain relationship between density and direct volumetry [J]. Invest Radiol, 2018, 53(4): 207-213.
11	Broocks G, Flottmann F, Scheibel A, et al. Quantitative lesion water uptake in acute stroke computed tomography is a predictor of malignant infarction [J]. Stroke, 2018, 49(8): 1906-1912.
12	Xu HB, Sun YF, Luo N, et al. Net water uptake calculated in standardized and blindly outlined regions of the middle cerebral artery territory predicts the development of malignant edema in patients with acute large hemispheric infarction [J]. Front Neurol, 2021, 12: 645590.
13	Fu BW, Qi SL, Tao L, et al. Image patch-based net water uptake and radiomics models predict malignant cerebral edema after ischemic stroke [J]. Front Neurol, 2020, 11: 609747.
14	Schirmer MD, Etherton DM, Dalca DA, et al. Effective reserve: a latent variable to improve outcome prediction in stroke [J]. J Stroke Cerebrovasc Dis, 2019, 28(1): 63-69.
15	Lee SH, Oh CW, Han JH, et al. The effect of brain atrophy on outcome after a large cerebral infarction [J]. J Neurol Neurosurg Psychiatry, 2010, 81(12): 1316-1321.
16	Thomalla GJ, Kucinski T, Schoder V, et al. Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging [J]. Stroke, 2003, 34(8): 1892-1899.
17	Beck C, Kruetzelmann A, Forkert ND, et al. A simple brain atrophy measure improves the prediction of malignant middle cerebral artery infarction by acute DWI lesion volume [J]. J Neurol, 2014, 261(6): 1097-1103.
18	Goto Y, Kumura E, Watabe T, et al. Prediction of malignant middle cerebral artery infarction in elderly patients [J]. J Stroke Cerebrovasc Dis, 2016, 25(6): 1389-1395.
19	Kauw F, Bennink E, de Jong H, et al. Intracranial cerebrospinal fluid volume as a predictor of malignant middle cerebral artery infarction [J]. Stroke, 2019, 50(6): 1437-1443.
20	Minnerup J, Wersching H, Ringelstein EB, et al. Prediction of malignant middle cerebral artery infarction using computed tomography-based intracranial volume reserve measurements [J]. Stroke, 2011, 42(12): 3403-3409.
21	Dhar R, Chen Y, Hamzehloo A, et al. Reduction in cerebrospinal fluid volume as an early quantitative biomarker of cerebral edema after ischemic stroke [J]. Stroke, 2020, 51(2): 462-467.
22	Ong CJ, Gluckstein J, Laurido-Soto O, et al. Enhanced detection of edema in malignant anterior circulation stroke (EDEMA) score: a risk prediction tool [J]. Stroke, 2017, 48(7): 1969-1972.
23	Cheng Y, Wu S, Wang Y, et al. External validation and modification of the EDEMA score for predicting malignant brain edema after acute ischemic stroke [J]. Neurocrit Care, 2020, 32(1): 104-112.
24	Bechstein M, Meyer L, Breuel S, et al. Computed tomography based score of early ischemic changes predicts malignant infarction [J]. Front Neurol, 2021, 12: 669828.
25	Muscari A, Faccioli L, Lega MV, et al. Predicting cerebral edema in ischemic stroke patients [J]. Neurol Sci, 2019, 40(4): 745-752.
26	Chen R, Deng Z, Song Z. The prediction of malignant middle cerebral artery infarction: a predicting approach using random forest [J]. J Stroke Cerebrovasc Dis, 2015, 24(5): 958-964.
27	Fu BW, Qi SL, Tao L, et al. Image patch-based net water uptake and radiomics models predict malignant cerebral edema after ischemic stroke [J]. Front Neurol, 2020, 11: 609747.
28	Foroushani HM, Hamzehloo A, Kumar A, et al. Quantitative serial CT imaging-derived features improve prediction of malignant cerebral edema after ischemic stroke [J]. Neurocrit Care, 2020, 33(3): 785-792.
29	Wang C, Gao L, Zhang ZG, et al. Procalcitonin is a stronger predictor of long-term functional outcome and mortality than high-sensitivity c-reactive protein in patients with ischemic stroke [J]. Mol Neurobiol, 2016, 53(3): 1509-1517.
30	Zhang Y, Liu G, Wang Y, et al. Procalcitonin as a biomarker for malignant cerebral edema in massive cerebral infarction [J]. Sci Rep, 2018, 8(1): 993.
31	Marumo T, Eto K, Wake H, et al. The inhibitor of 20-HETE synthesis, TS-011, improves cerebral microcirculatory autoregulation impaired by middle cerebral artery occlusion in mice [J]. Br J Pharmacol, 2010, 161(6): 1391-1402.
32	Yi X, Zhou Q, Qing T, et al. 20-hydroxyeiscosatetraenoic acid may be as a predictor of malignant middle cerebral artery infarction in patients with massive middle cerebral artery infarction [J]. BMC Neurol, 2021, 21(1): 437.
33	Zhao YH, Gao H, Pan ZY, et al. Prognostic value of NT-proBNP after ischemic stroke: a systematic review and meta-analysis of prospective cohort studies [J]. J Stroke Cerebrovasc Dis, 2020, 29(4): 104659.
34	Zhang X, Yan S, Zhong W, et al. Early NT-ProBNP (N-terminal probrain natriuretic peptide) elevation predicts malignant edema and death after reperfusion therapy in acute ischemic stroke patients [J]. Stroke, 2021, 52(2): 537-542.
35	Bai XL, Wang CY, Wang L, et al. Association between neutrophil to lymphocyte ratio and malignant brain edema in patients with large hemispheric infarction [J]. Curr Neurovasc Res, 2020, 17(4): 429-436.
36	Gao L, Dong Q, Song Z, et al. NLRP3 inflammasome: a promising target in ischemic stroke [J]. Inflamm Res, 2017, 66(1): 17-24.
37	Wang HN, Chen HP, Jin J, et al. Inhibition of the NLRP3 inflammasome reduces brain edema and regulates the distribution of aquaporin-4 after cerebral ischaemia-reperfusion [J]. Life Sci, 2020, 251: 117638.
38	Wang Y, Huang H, He W, et al. Association between serum NLRP3 and malignant brain edema in patients with acute ischemic stroke [J]. BMC Neurol, 2021, 21(1): 341.

[1]	李甲, 沈罡, 朱光耀, 陈茂送, 王波定. 大面积脑梗死去骨瓣减压术后迟发性脑过度灌注综合征的危险因素分析[J]. 中华危重症医学杂志(电子版), 2022, 15(02): 111-117.
[2]	陈勇, 张玲, 詹永婧, 段毓姣, 徐艳利, 蒋荣猛, 李兴旺. 神经梅毒强化驱梅治疗疗效预测因素的回顾性研究[J]. 中华实验和临床感染病杂志(电子版), 2016, 10(03): 274-279.
[3]	何坤, 阮嘉后, 储兵, 周载平, 黄锐钦, 胡泽民. 肝癌衍生生长因子在原发性肝内胆管细胞癌中的表达及其临床意义[J]. 中华普通外科学文献(电子版), 2015, 09(04): 291-295.
[4]	黄骁, 项建斌. 局部复发直肠癌的外科治疗进展[J]. 中华结直肠疾病电子杂志, 2021, 10(06): 643-647.
[5]	王宏宇, 李刚, 李宏宇. 双侧慢性硬膜下血肿术后并发大面积脑梗死1例报道并文献复习[J]. 中华神经创伤外科电子杂志, 2023, 09(01): 58-61.
[6]	孔海波, 焦永成, 苏新文, 刘爱军, 查炜光. 外伤后动脉性大面积脑梗死的相关危险因素分析[J]. 中华神经创伤外科电子杂志, 2019, 05(02): 79-82.
[7]	黄贤键, 马宇强, 高杰, 张杰华, 刘俊, 陈保东. 创伤性大面积脑梗死的相关危险因素分析[J]. 中华神经创伤外科电子杂志, 2016, 02(03): 144-147.
[8]	丁玉菊, 刘照勇, 张波. 获得性脑损伤患者成功拔除气管套管的预测因素研究[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(02): 108-112.
[9]	翁梓珑, 朱丽, 林大卫, 潘文志, 周达新, 葛均波. 国产经导管瓣膜系统治疗重度主动脉瓣狭窄长期预后及其预测因素分析[J]. 中华心脏与心律电子杂志, 2023, 11(02): 114-119.
[10]	郑屹, 谢冰歆, 刘彤. 白细胞端粒长度与心房颤动相关性研究进展[J]. 中华心脏与心律电子杂志, 2022, 10(04): 246-249.
[11]	薛宇龙, 李学文. 冠脉慢血流现象相关预测因素的研究[J]. 中华心脏与心律电子杂志, 2017, 05(04): 225-228.
[12]	赵悦, 马士凤, 周娜, 王茜, 张聪, 刘笑孝, 蒋海燕, 程思琪, 郑荣秀. 儿童代谢健康型肥胖的发病机制及预测指标[J]. 中华肥胖与代谢病电子杂志, 2022, 08(01): 52-55.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Research progress in predictive factors of malignant cerebral edema after cerebral infarction

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Research progress in predictive factors of malignant cerebral edema after cerebral infarction