Matsayin asibiti na Citicoline hakika yana fuskantar wani muhimmin canji, a hankali yana tasowa daga "magani na adjuvant" na gargajiya zuwa "maganin neuroprotective". Wannan canji ba shi da tushe, amma dangane da ci gaba da tattara bayanan shaidar likitancin shaida, zurfin fahimtar tsarin aikinta na manufa da yawa, da kuma mahimmancin fahimtar "tagar lokaci" a cikin maganin raunin jijiya mai tsanani. Wa?annan su ne mahimman tushe da nazari wa?anda ke goyan bayan wannan sauyi:

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1. ?arfin tu?i: ?arfi mai ?arfi daga tsarin aiki zuwa aikin asibiti

Sake gwada tsarin aikin (bayan 'taimako'):

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Membrane phospholipid core gyara: Cytophosphatidylcholine ne kai tsaye precursor don kira na cell membrane phospholipids, kamar phosphatidylcholine. Membrane phospholipid deradaration wani abu ne mai mahimmanci na farko da ya faru bayan ischemia / hypoxia neuronal. Phosphatidylcholine na iya ha?aka kayan ha?in phospholipid na endogenous kai tsaye, inganta ha?akar membrane na jijiyar jijiyoyi da kwanciyar hankali, wanda shine tushen tushen neuroprotection.

Multi manufa neuroprotective effects:

Rage excitotoxicity: hana wuce kima saki da guba na glutamate.

Danniya na antioxidant: yana ?ara matakan glutathione kuma yana share radicals kyauta.

Inganta aikin mitochondrial: kula da makamashin makamashi da rage apoptosis cell.

Ha?aka ha?akar ?wayoyin cuta: ha?aka matakan acetylcholine, dopamine, da sauransu, inganta ha?akar jijiya.

Rage neuroinflammation: hana sakin cytokines pro-mai kumburi.

Na'urar ta ?ayyade cewa ya kamata ya zama ainihin aikin "sa baki na farko da kariya mai aiki", maimakon kawai mataimaki don taimako na alama. "

Tarin ?wa??waran shaida na tushen shaida (karye ta hanyar ra'ayi na "mataimaki"):

Babban bugun jini na ischemic (AIS):

Nazarin ICTUS (2012): Ko da yake farkon ?arshen ?arshen ya kasance mara kyau, ?ungiyoyin da aka ?addara (matsakaici zuwa bugun jini mai tsanani, jiyya na farko) sun nuna fa'idodi masu mahimmanci, suna nuna cewa lokacin jiyya da za?in yawan jama'a suna da mahimmanci.

Nazarin ECCO 2 (2023): babban RCT da aka gudanar a cikin yawan jama'ar kasar Sin (marasa lafiya AIS 3947 sun ha?a). Sakamakon ya nuna cewa a kan tushen thrombolysis na ciki da / ko maganin endovascular, da wuri (a cikin sa'o'i 24 bayan farawa) yin amfani da phosphatidylcholine na jini don kwanaki 14 ya karu da adadin 90 na 'yancin kai na aiki (mRS 0-1) (43.5% vs 40.0%), kuma aminci yana da kyau. Tabbatar da tasirinsa na ha?in gwiwa akan daidaitaccen maganin maimaitawa. "

Matsakaicin meta-bincike: goyan bayan tasirin sa don ha?aka sakamakon jijiya da iya rayuwar yau da kullun, musamman fara jiyya a farkon matakan farawa (

Raunin ?wa?walwar ?wa?walwa (TBI):

Nazarin COBRIT: Sakamakon yana da rigima, amma bincike na gaba ya nuna cewa takamaiman ?ungiyoyi (matsakaicin zuwa TBI mai tsanani) suna amfana.

Binciken duniya na ainihi & meta-bincike: Nazarin da yawa sun nuna cewa zai iya inganta sakamakon neurological da farfadowa da hankali a cikin marasa lafiya na TBI.

Cututtukan Neurodegenerative (a ?ar?ashin bincike):

Rashin ladabi mai zurfi (VCI) / VCI) / VIDCular Dementia (VAD): Nazari sun nuna cewa zai iya inganta hankali aiki (hankali, ?wa?walwa).

Cutar Alzheimer (AD)/Cutar Parkinson (PD): A matsayin masu iya canza cututtuka, wasu ?ananan nazarin suna ba da shawarar ha?akawa da ha?akawa.

Bincike a wasu fagage irin su glaucoma da raunin kashin baya ya kuma nuna yuwuwar neuroprotective.

2. Mahimmin batu na sakawa canji: daga "mataimaki" zuwa "core"

Matsar da lokacin jiyya gaba (babban sa baki na "tagan lokacin zinariya"):

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Makullin kariya ga neuroprotection yana cikin 'da wuri'. Bayan raunin kwakwalwa (kamar bugun jini, TBI), an fara amsa raunin da ya faru bayan mintuna da yawa zuwa sa'o'i da yawa daga baya.

Hanyar aikin phosphatidylcholine ya ?ayyade cewa ya kamata a yi amfani da shi a farkon matakan raunin raunin da ya faru (kamar a cikin sa'o'i 24 bayan bugun jini, da farko ya fi kyau) don toshe hanyar rauni da kuma kare kyallen jikin da ke cikin ha?ari zuwa mafi girman yiwuwar. Wannan ya sha bamban kwata-kwata da matsayin gargajiya na "maganin gyaran fuska".

Nasarar binciken ECCO 2 ya dogara ne akan ?irar ka'idojin gudanarwa na farkon jijiya.

Babban matsayi na dabarun jiyya (ha?e tare da reperfusion far):

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Bidi'a a cikin yanayin jiyya na mummunan bugun jini na ischemic: Ma'auni na magani shine recanalization na jijiyoyin jini (thrombolysis, thrombectomy), amma yawancin marasa lafiya har yanzu suna da mummunan tsinkaye bayan an sake dawowa (rauni na reperfusion, babu wani abu na sake dawowa, da dai sauransu).

Tsarin neuroprotective na phosphatidylcholine (stabilization cell membrane, antioxidant, anti apoptotic) na iya daidaitawa da aiki tare da reperfusion far, rage reperfusion rauni da kuma kare kwakwalwa nama bayan reperfusion.

Binciken ECCO 2 ya tabbatar da ?imar sa a matsayin babban ?angaren neuroprotective a cikin dabarun "recanalization na jijiyoyin jini +", ba ?ari kawai na za?i na za?i ba.

Ha?aka hanyoyin gudanarwa (neman bioavailability):

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Fosphatidylcholine na baka yana da ?arancin bioavailability (

Allurar cikin jijiya na iya samar da babban bioavailability, da sauri cimma tasiri mai tasiri na magungunan jini, da saduwa da bu?atun saurin neuroprotection a cikin matsanancin lokaci.

Juyawa zuwa matsayi na "kwakwalwa" ba makawa zai kasance tare da shawarwarin nau'ikan allurai na cikin jijiya don amfani a cikin matsanancin lokaci.

3. Sabunta jagororin / yarjejeniya (yana nuna canji a matsayi)

China:

"Sharu??a don Rigakafin da Magance cutar bugun jini a kasar Sin" da wasu takardu sun nuna tasirin sa na kare lafiyar jiki.

Dangane da sakamakon da aka samu na binciken ECCO 2, ana sa ran cewa matakin shawarwari da sanya phosphatidylcholine (musamman tsarin jijiya da aka yi amfani da shi a cikin babban lokaci) a cikin jagororin kasar Sin za su inganta sosai nan gaba. "

Na duniya:

Ka'idodin AHA / ASA a Amurka ba su riga sun ba da shawarar a sarari ba, amma suna bu?e don bincike kan ma'aikatan neuroprotective.

Wasu jagororin ?asashen Turai suna da ingantaccen kimantawa na phosphatidylcholine (kamar Spain, Portugal).

4. Muhimmancin canji na asibiti

Sabunta ra'ayi na jiyya: Neuroprotection shine ginshi?i mai mahimmanci daidai a cikin maganin mummunan rauni na kwakwalwa kamar farfadowa na jijiyoyin jini.

Inganta tsarin kulawa: Ha?aka ha?in ha?in gwiwa na phosphatidylcholine (jiki) a matsayin daidaitaccen magani (kamar thrombolysis / thrombectomy) a cikin hyperacute / m lokaci na bugun jini / TBI da sauran cututtuka.

Ha?aka tsinkayar ha?uri: Ta hanyar farkon da ingantaccen neuroprotection, ana sa ran ?ara ha?aka ?imar rayuwa da matakin dawo da aiki na marasa lafiya da ke fama da raunin kwakwalwa, da rage nakasa.

Ha?aka bincike da jagorar ha?akawa: Ha?aka ?arin ingantaccen karatun asibiti da bincika sabbin hanyoyin isar da magunguna don ?a??arfan neuroprotection.

Summary da Outlook

Canji na phosphatidylcholine daga "maganin magani" zuwa "maganin neuroprotective" shine sakamakon zurfafa bincike na asali, nasarori a cikin shaidar asibiti (musamman bincike na ECCO 2), da sabunta ra'ayoyin jiyya. Asalinsa yana cikin:

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Sa baki da wuri: ?addamar da magani a lokacin taga lokacin zinare (m lokaci mai zurfi / matakin farko) lokacin da aka fara cutar da raunin jijiya.

Mahimmancin Jiki: A cikin matsanancin lokaci inda ake bu?atar aiwatar da gaggawa, gudanarwar jijiya ita ce hanya mai mahimmanci don aiwatar da tasirin kariya.

Ha?aka ingantaccen aiki na ha?in gwiwa: A matsayin babban abin da ke da mahimmanci na neuroprotection akan tushen jiyya na farfadowa na jijiyoyin jini (bugun jini) ko cikakkiyar jiyya (TBI), ba ?ari ba ne.

Wannan sauye-sauye yana nuna alamar sabuntawa da ha?aka darajar phosphatidylcholine a cikin maganin cututtuka na jijiyoyi, musamman ma a cikin tsarin jiyya na bugun jini mai tsanani. A matsayin muhimmin ?angare na dabarun “madaidaicin reperfusion far + core neuroprotection” dabarun, yana ?ara samun tabbataccen goyon baya na tushen shaida da sanin asibiti. A nan gaba, tare da ha?aka ?arin ingantaccen bincike da sabuntawa ga jagororin, za a ?ara ?arfafa ainihin matsayinsa.