法医学杂志 ›› 2024, Vol. 40 ›› Issue (4): 372-378.DOI: 10.12116/j.issn.1004-5619.2024.440303
• 综述 • 上一篇
收稿日期:
2024-03-04
发布日期:
2024-11-08
出版日期:
2024-08-25
通讯作者:
张国忠
作者简介:
王建峰(1996—),男,硕士研究生,主要从事法医病理学研究;E-mail:20212152@stu.hebmu.edu.cn
基金资助:
Jian-feng WANG1(), Chen-teng YANG1, Guo-zhong ZHANG1,2(
), Bin CONG1,3
Received:
2024-03-04
Online:
2024-11-08
Published:
2024-08-25
Contact:
Guo-zhong ZHANG
摘要:
脑心综合征是指由各种颅脑损伤病变引起的继发性心脏损害,可加重原本存在的心脏疾病。在法医病理学实践中,对于颅脑损伤后短时间内死亡的案例,特别是伴有心脏基础疾病的案例,常会忽视脑心的交互作用。本文通过整理近年来国内外有关脑心综合征的研究成果,系统综述了脑心综合征的发病机制,并探讨其在法医学领域的重要意义,以期为脑心综合征的法医学实践提供帮助。
中图分类号:
王建峰, 杨琛腾, 张国忠, 丛斌. 脑心综合征研究进展及其法医学意义[J]. 法医学杂志, 2024, 40(4): 372-378.
Jian-feng WANG, Chen-teng YANG, Guo-zhong ZHANG, Bin CONG. Advances in the Study of Cerebrocardiac Syndrome and Its Forensic Significance[J]. Journal of Forensic Medicine, 2024, 40(4): 372-378.
1 | LIN H B, LI F X, ZHANG J Y, et al. Cerebral-cardiac syndrome and diabetes: Cardiac damage after ischemic stroke in diabetic state[J]. Front Immunol,2021,12:737170. doi:10.3389/fimmu.2021.737170 . |
2 | TAHSILI-FAHADAN P, GEOCADIN R G. Heart-brain axis: Effects of neurologic injury on cardiovascular function[J]. Circ Res,2017,120(3):559-572. doi:10.1161/CIRCRESAHA.116.308446 . |
3 | 郑钰蓉,殷梅,罗悯. 急性缺血性脑卒中伴发脑心综合征的临床研究[J].医学信息,2022,35(17):156-160. doi:10.3969/j.issn.1006-1959.2022.17.043 . |
ZHENG Y R, YIN M, LUO M. Clinical study of acute ischemic stroke with cerebrocardiac syndrome[J]. Yixue Xinxi,2022,35(17):156-160. | |
4 | WANG J, ZHANG J, YE Y, et al. Peripheral organ injury after stroke[J]. Front Immunol,2022,13:901209. doi:10.3389/fimmu.2022.901209 . |
5 | LI W, LI L, CHOPP M, et al. Intracerebral hemorrhage induces cardiac dysfunction in mice without primary cardiac disease[J]. Front Neurol,2018,9:965. doi:10.3389/fneur.2018.00965 . |
6 | SPOSATO L A, LAM M, ALLEN B, et al. First-ever ischemic stroke and increased risk of incident heart disease in older adults[J]. Neurology,2020,94(15):e1559-e1570. doi:10.1212/WNL.0000000000009234 . |
7 | MORRIS N A, CHATTERJEE A, ADEJUMO O L, et al. The risk of Takotsubo cardiomyopathy in acute neurological disease[J]. Neurocrit Care,2019,30(1):171-176. doi:10.1007/s12028-018-0591-z . |
8 | CHEN Z, VENKAT P, SEYFRIED D, et al. Brain-heart interaction: Cardiac complications after stroke[J]. Circ Res,2017,121(4):451-468. doi:10.1161/CIRCRE SAHA.117.311170 . |
9 | ZHAO B, LI T, FAN Z, et al. Heart-brain connections: Phenotypic and genetic insights from magnetic resonance images[J]. Science,2023,380(6648):abn6598. doi:10.1126/science.abn6598 . |
10 | WANG M, PENG Y. Advances in brain-heart syndrome: Attention to cardiac complications after ische-mic stroke[J]. Front Mol Neurosci,2022,15:1053478. doi:10.3389/fnmol.2022.1053478 . |
11 | BALINT B, JAREMEK V, THORBURN V, et al. Left atrial microvascular endothelial dysfunction, myocardial inflammation and fibrosis after selective insular cortex ischemic stroke[J]. Int J Cardiol,2019,292:148-155. doi:10.1016/j.ijcard.2019.06.004 . |
12 | KRAUSE T, WERNER K, FIEBACH J B, et al. Stroke in right dorsal anterior insular cortex is related to myocardial injury[J]. Ann Neurol,2017,81(4):502-511. doi:10.1002/ana.24906 . |
13 | BATTAGLINI D, ROBBA C, LOPES DA SILVA A, et al. Brain-heart interaction after acute ischemic stroke[J]. Crit Care,2020,24(1):163. doi:10.1186/s13054-020-02885-8 . |
14 | SCHEITZ J F, NOLTE C H, DOEHNER W, et al. Stroke-heart syndrome: Clinical presentation and underlying mechanisms[J]. Lancet Neurol,2018,17(12):1109-1120. doi:10.1016/S1474-4422(18)30336-3 . |
15 | WANG Y, HU H, YIN J, et al. TLR4 participates in sympathetic hyperactivity post-MI in the PVN by regulating NF-κB pathway and ROS production[J]. Redox Biol,2019,24:101186. doi:10.1016/j.redox.2019.101186 . |
16 | INFANGER D W, CAO X, BUTLER S D, et al. Silencing Nox4 in the paraventricular nucleus improves myocardial infarction-induced cardiac dysfunction by attenuating sympathoexcitation and periinfarct apoptosis[J]. Circ Res,2010,106(11):1763-1774. doi:10.1161/CIRCRESAHA.109.213025 . |
17 | NISTOR I R, GHERASIM L. From neurocardiology to stroke-heart syndrome[J]. Rom J Intern Med,2023,61(4):177-185. doi:10.2478/rjim-2023-0020 . |
18 | DU Y X, DEMILLARD L J, REN J. Catecholamine-induced cardiotoxicity: A critical element in the pathophysiology of stroke-induced heart injury[J]. Life Sci,2021,287:120106. doi:10.1016/j.lfs.2021.120106 . |
19 | XU H X, CUI S M, ZHANG Y M, et al. Mitochondrial Ca2+ regulation in the etiology of heart failure: Physiological and pathophysiological implications[J]. Acta Pharmacol Sin,2020,41(10):1301-1309. doi:10.1038/s41401-020-0476-5 . |
20 | ANDREIS D T, SINGER M. Catecholamines for inflammatory shock: A Jekyll-and-Hyde conundrum[J]. Intensive Care Med,2016,42(9):1387-1397. doi:10.1007/s00134-016-4249-z . |
21 | 郭彩霞,杜凤和,陈瑞芬,等. 大鼠颅脑损伤后心肌损害和血浆及心肌血管紧张素的变化[J].基础医学与临床,2003,23(1):72-75. doi:10.3969/j.issn.1001-6325.2003.01.016 . |
GUO C X, DU F H, CHEN R F, et al. Myocardial damage, changes of plasma A Ⅱ as well as myocardial A Ⅱ and AT1 receptor after brain injury in rats[J]. Jichu Yixue Yu Linchuang,2003,23(1):72-75. | |
22 | LU Y, LI S, WU H, et al. Beneficial effects of astragaloside Ⅳ against angiotensin Ⅱ-induced mitochondrial dysfunction in rat vascular smooth muscle cells[J]. Int J Mol Med,2015,36(5):1223-1232. doi:10.3892/ijmm.2015.2345 . |
23 | LIJNEN P J, VAN PELT J F, FAGARD R H. Downregulation of manganese superoxide dismutase by angiotensin Ⅱ in cardiac fibroblasts of rats: Association with oxidative stress in myocardium[J]. Am J Hypertens,2010,23(10):1128-1135. doi:10.1038/ajh.2010.128 . |
24 | 王东晨,高源勋,孟昭阳. 中西医治疗脑心综合征的研究进展[J].中西医结合心脑血管病杂志,2021,19(4):611-614. doi:10.12102/j.issn.1672-1349.2021.04.021 . |
WANG D C, GAO Y X, MENG Z Y. Research progress of cerebrocardiac syndrome treated by traditional Chinese and western medicine[J]. Zhongxiyi Jiehe Xinnaoxueguanbing Zazhi,2021,19(4):611-614. | |
25 | 刘文通,赵轩竹,陈宝贵. 脑心综合征的中西医研究进展[J].中医药导报,2020,26(10):151-153,164. doi:10.13862/j.cnki.cn43-1446/r.2020.10.036 . |
LIU W T, ZHAO X Z, CHEN B G. Research advancements of traditional Chinese and western medicine in cerebral-cardiac syndrome[J]. Zhongyiyao Daobao,2020,26(10):151-153,164. | |
26 | VAN DER BILT I A C, VENDEVILLE J P, VAN DE HOEF T P, et al. Myocarditis in patients with subarachnoid hemorrhage: A histopathologic study[J]. J Crit Care,2016,32:196-200. doi:10.1016/j.jcrc.2015.12.005 . |
27 | DENG S W, CHEN X Q, LEI Q, et al. AQP2 promotes astrocyte activation by modulating the TLR4/NFκB-p65 pathway following intracerebral hemorrhage[J]. Front Immunol,2022,13:847360. doi:10 . |
3389/fimmu.2022.847360. | |
28 | ZHAO H, ZHANG K, TANG R, et al. TRPV4 blockade preserves the blood-brain barrier by inhi-biting stress fiber formation in a rat model of intracerebral hemorrhage[J]. Front Mol Neurosci,2018,11:97. doi:10.3389/fnmol.2018.00097 . |
29 | LI W, LI L, LI W, et al. Spleen associated immune-response mediates brain-heart interaction after intracerebral hemorrhage[J]. Exp Neurol,2020,327:113209. doi:10.1016/j.expneurol.2020.113209 . |
30 | WANG L F, NEGRO R, WU H. TRPM2, linking oxidative stress and Ca2+ permeation to NLRP3 inflammasome activation[J]. Curr Opin Immunol,2020,62:131-135. doi:10.1016/j.coi.2020.01.005 . |
31 | HE W, CHEN P, CHEN Q, et al. Cytokine storm: Behind the scenes of the collateral circulation after acute myocardial infarction[J]. Inflamm Res,2022,71(10/11):1143-1158. doi:10.1007/s00011-022-01611-0 . |
32 | KUMAR S, WANG G, ZHENG N, et al. HIMF (hypoxia-induced mitogenic factor)-IL (interleukin)-6 signaling mediates cardiomyocyte-fibroblast crosstalk to promote cardiac hypertrophy and fibrosis[J]. Hypertension,2019,73(5):1058-1070. doi:10.1161/hyperten sionaha.118.12267 . |
33 | ZHENG J, MA Y, GUO X, et al. Immunological characterization of stroke-heart syndrome and identification of inflammatory therapeutic targets[J]. Front Immunol,2023,14:1227104. doi:10.3389/fimmu.2023.1227104 . |
34 | XU C, ZHENG A, HE T, et al. Brain-heart axis and biomarkers of cardiac damage and dysfunction after stroke: A systematic review and meta-analysis[J]. Int J Mol Sci,2020,21(7):2347. doi:10.3390/ijms21072347 . |
35 | CRAPSER J, RITZEL R, VERMA R, et al. Ischemic stroke induces gut permeability and enhances bacterial translocation leading to sepsis in aged mice[J]. Aging,2016,8(5):1049-1063. doi:10.18632/aging.100952 . |
36 | LI X J, YOU X Y, WANG C Y, et al. Bidirectional Brain-gut-microbiota Axis in increased intestinal permeability induced by central nervous system injury[J]. CNS Neurosci Ther,2020,26(8):783-790. doi:10.1111/cns.13401 . |
37 | PAN P, SONG Y, DU X, et al. Intestinal barrier dysfunction following traumatic brain injury[J]. Neurol Sci,2019,40(6):1105-1110. doi:10.1007/s10072-019-03739-0 . |
38 | WEN S W, WONG C H Y. An unexplored brain-gut microbiota axis in stroke[J]. Gut Microbes,2017,8(6):601-606. doi:10.1080/19490976.2017.1344809 . |
39 | GAO H, LIU S. Role of uremic toxin indoxyl sulfate in the progression of cardiovascular disease[J]. Life Sci,2017,185:23-29. doi:10.1016/j.lfs.2017.07.027 . |
40 | LEKAWANVIJIT S, ADRAHTAS A, KELLY D J, et al. Does indoxyl sulfate, a uraemic toxin, have direct effects on cardiac fibroblasts and myocytes?[J]. Eur Heart J,2010,31(14):1771-1779. doi:10.1093/eurheartj/ehp574 . |
41 | WITKOWSKI M, WEEKS T L, HAZEN S L. Gut microbiota and cardiovascular disease[J]. Circ Res,2020,127(4):553-570. doi:10.1161/CIRCRESAHA.120.316242 . |
42 | NEMET I, SAHA P P, GUPTA N, et al. A cardiovascular disease-linked gut microbial metabolite acts via adrenergic receptors[J]. Cell,2020,180(5):862-877.e22. doi:10.1016/j.cell.2020.02.016 . |
43 | ZHOU Y, DENG L, ZHAO D, et al. MicroRNA-503 promotes angiotensin Ⅱ-induced cardiac fibrosis by targeting Apelin-13[J]. J Cell Mol Med,2016,20(3):495-505. doi:10.1111/jcmm.12754 . |
44 | CHEN J, CUI C, YANG X, et al. MiR-126 affects brain-heart interaction after cerebral ischemic stroke[J]. Transl Stroke Res,2017,8(4):374-385. doi:10.1007/s12975-017-0520-z . |
45 | ZHANG L, LIU T, WANG P, et al. Overexpression of long noncoding RNA H19 inhibits cardiomyocyte apoptosis in neonatal rats with hypoxic-ischemic brain damage through the miR-149-5p/LIF/PI3K/Akt axis[J]. Biopreserv Biobank,2021,19(5):376-385. doi:10.1089/bio.2020.0088 . |
46 | CLIMENT M, QUINTAVALLE M, MIRAGOLI M, et al. TGFβ triggers miR-143/145 transfer from smooth muscle cells to endothelial cells, thereby modu-lating vessel stabilization[J]. Circ Res,2015,116(11):1753-1764. doi:10.1161/CIRCRESAHA.116.305178 . |
47 | WANG L, YUAN Y, LI J, et al. MicroRNA-1 aggravates cardiac oxidative stress by post-transcriptional modification of the antioxidant network[J]. Cell Stress Chaperones,2015,20(3):411-420. doi:10.1007/s12192-014-0565-9 . |
48 | WANG M, YANG Y, XU Y. Brain nuclear receptors and cardiovascular function[J]. Cell Biosci,2023,13(1):14. doi:10.1186/s13578-023-00962-3 . |
49 | SHIH C D. Activation of estrogen receptor beta-dependent nitric oxide signaling mediates the hypotensive effects of estrogen in the rostral ventrolateral medulla of anesthetized rats[J]. J Biomed Sci,2009,16(1):60. doi:10.1186/1423-0127-16-60 . |
50 | XUE B, ZHANG Z, BELTZ T G, et al. Estrogen receptor-β in the paraventricular nucleus and rostroventrolateral medulla plays an essential protective role in aldosterone/salt-induced hypertension in female rats[J]. Hypertension,2013,61(6):1255-1262. doi:10 . |
1161/HYPERTENSIONAHA.111.00903. | |
51 | KONERU B, BATHINA C S, CHERRY B H, et al. Mineralocorticoid receptor in the NTS stimulates saline intake during fourth ventricular infusions of aldosterone[J]. Am J Physiol Regul Integr Comp Physiol,2014,306(1):R61-R66. doi:10.1152/ajpregu.00434.2013 . |
52 | WALTERS K A, EDWARDS M C, TESIC D, et al. The role of central androgen receptor actions in regulating the hypothalamic-pituitary-ovarian axis[J]. Neuroendocrinology,2018,106(4):389-400. doi:10.1159/000487762 . |
53 | GHOSAL S, BUNDZIKOVA-OSACKA J, DOLGAS C M, et al. Glucocorticoid receptors in the nucleus of the solitary tract (NTS) decrease endocrine and behavioral stress responses[J]. Psychoneuroendocrino-logy,2014,45:142-153. doi:10.1016/j.psyneuen.2014.03.018 . |
54 | LEE P W, SELHORST A, LAMPE S G, et al. Neuron-specific vitamin D signaling attenuates microglia activation and CNS autoimmunity[J]. Front Neurol,2020,11:19. doi:10.3389/fneur.2020.00019 . |
55 | 熊昌艳,王永忠,朱宝利,等. 交通事故后心脏自发性破裂1例[J].法医学杂志,2009,25(5):398-399. doi:10.3969/j.issn.1004-5619.2009.05.033 . |
XIONG C Y, WANG Y Z, ZHU B L, et al. Spontaneous cardiac rupture after a traffic accident: A case report[J]. Fayixue Zazhi,2009,25(5):398-399. | |
56 | FAN X, DU F H, TIAN J P. The electrocardiographic changes in acute brain injury patients[J]. Chin Med J (Engl),2012,125(19):3430-3433. doi:10.3760/ cma.j.issn.0366-6999.2012.19.013 . |
57 | 王蒙蒙. 急性脑梗死并发脑心综合征的临床回顾性分析[D].长春:吉林大学,2018. |
WANG M M. Retrospective analysis of acute cerebral infraction and cerebro-cardiac syndrome[D]. Chang-chun: Jilin University,2018. | |
58 | ORAS J, GRIVANS C, BARTLEY A, et al. Elevated high-sensitive troponin T on admission is an indicator of poor long-term outcome in patients with subarachnoid haemorrhage: A prospective observational study[J]. Crit Care,2016,20:11. doi:10.1186/s13054-015-1181-5 . |
59 | KIM W, CHOI K S, LIM T, et al. Prognostic value of echocardiography for left ventricular dysfunction after aneurysmal subarachnoid hemorrhage: A syste-matic review and meta-analysis[J]. World Neurosurg,2019,126:e1099-e1111. doi:10.1016/j.wneu.2019.03.054 . |
60 | 柴亮,赵子平,曹亚云,等. 超声心动图评估急性脑损伤患者的左心室功能[J].中华医学超声杂志(电子版),2019,16(4):301-305. doi:10.3877/cma.j.issn.1672-6448.2019.04.012 . |
CHAI L, ZHAO Z P, CAO Y Y, et al. Comparative assessment of left ventricular function in patients with acute brain injury[J]. Zhonghua Yixue Chaosheng Zazhi (Electronic edition),2019,16(4):301-305. |
[1] | 李霁伦, 罗超, 范颖, 汪家文, 张建华. 20例泌尿外科死亡案例的医疗损害鉴定结果分析[J]. 法医学杂志, 2024, 40(4): 359-364. |
[2] | 郭文青, 陈敏, 马骜, 黄平, 张吉. 蛋白酶-过氧化氢消解法在法医学硅藻检验中的应用[J]. 法医学杂志, 2024, 40(4): 317-323. |
[3] | 李艳红, 许小明, 熊思齐, 刘世奇, 熊小亮. 右冠状动脉扩张并血栓形成猝死1例[J]. 法医学杂志, 2024, 40(3): 291-292. |
[4] | 刘晋廷, 周莉英, 相佳宏, 李子怡, 谢婉婷, 贠克明, 施妍. 哌嗪类新精神活性物质体内检测研究进展[J]. 法医学杂志, 2024, 40(3): 276-283. |
[5] | 方伟, 郑吉龙, 付奕铭, 刘轶. 利用犬类嗅觉搜索人体遗骸研究进展[J]. 法医学杂志, 2024, 40(3): 269-275. |
[6] | 陈念念, 余娇芳, 吴鹏, 罗丽, 白雅琴, 王利凯, 李晓倩, 李展鹏, 高彩荣, 郭相杰. 基于代谢组学分析急性心肌梗死大鼠尿液代谢物变化[J]. 法医学杂志, 2024, 40(3): 227-236. |
[7] | 陈光, 王小龙, 项慧敏, 汪露, 秦明, 刘岫, 徐祥. 虚拟解剖结合法医学尸体检验判定气枪弹创致死1例[J]. 法医学杂志, 2024, 40(2): 196-199. |
[8] | 宋旦, 单华鑫, 王福远, 李正东. 压缩式垃圾车挤压致死1例[J]. 法医学杂志, 2024, 40(2): 205-207. |
[9] | 王悦, 刘希, 李广云, 刘明哲, 陈新山. 腹股沟疝修补术中恶性高热死亡法医学鉴定1例[J]. 法医学杂志, 2024, 40(2): 208-210. |
[10] | 施蕾, 薛冶, 邱丽蓉, 鲁婷, 范飞, 周宇驰, 邓振华. 基于磁共振成像技术的牙龄推断研究进展[J]. 法医学杂志, 2024, 40(2): 112-117. |
[11] | 黄武林, 李玲玉, 彭建伟, 邹梦琴, 章青波. 毒性弥漫性甲状腺肿并发脑梗死法医学鉴定1例[J]. 法医学杂志, 2024, 40(2): 199-201. |
[12] | 陈尚亨, 董盛仲, 王智敏, 洪光辉, 叶星, 林子杰, 林俊毅, 江洁清, 王守宇, 林汉成, 沈忆文. 束缚应激致高脂血症ApoE-/-小鼠心肌损伤的分子靶标筛选与机制分析[J]. 法医学杂志, 2024, 40(2): 172-178. |
[13] | 景嘉钰, 徐璐瑶, 杜思昊, 岳霞, 乔东访. 宏基因组测序辅助鉴定输液致血流感染死亡1例[J]. 法医学杂志, 2024, 40(2): 211-216. |
[14] | 吴娟娟, 黄俊杰, 张煜, 卓嘉英, 陈刚, 杨舒涵, 赵蕴琦, 范琰琰. IL-10、TGF-β1在小鼠深静脉血栓中的时序性变化[J]. 法医学杂志, 2024, 40(2): 179-185. |
[15] | 李丹阳, 潘宇, 周慧明, 万雷, 李成涛, 汪茂文, 王亚辉. 医学统计和机器学习方法在活体年龄推断中的应用[J]. 法医学杂志, 2024, 40(2): 118-127. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||