Kumisikidzwa kwekiriniki yeCiticoline zvechokwadi kuri kuita shanduko yakakosha, zvishoma nezvishoma ichibva kune yechinyakare "adjuvant drug" kuenda ku "core neuroprotective agent". Kushandurwa uku hakusi kwepasi, asi kunobva pakuunganidza kunoramba kuripo kweuchapupu-hwakavakirwa mushonga humbowo, kunzwisiswa kwakadzama kwemaitiro ayo akawanda anonangwa ekuita, uye kucherechedzwa kwakasimba kwe "nguva yehwindo" mukurapa kwekukuvara kwakanyanya kwetsinga. Aya anotevera ndiwo akakosha hwaro uye ongororo dzinotsigira shanduko iyi:

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1, Core kutyaira simba: Uchapupu hwakasimba kubva kune michina kuenda kukiriniki maitiro

Kuongororwazve kwemaitiro echiito (kupfuura 'rubatsiro'):

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Membrane phospholipid kugadzirisa musimboti: Cytophosphatidylcholine ndiyo yakananga precursor ye synthesis ye cell membrane phospholipids, senge phosphatidylcholine. Membrane phospholipid degradation chiitiko chekutanga chekukuvara mushure meuronal ischemia/hypoxia. Phosphatidylcholine inogona kuwedzera zvakananga endogenous phospholipid synthesis zvinhu, kukurudzira yakakuvadzwa nerve cell membrane kugadzirisa uye kugadzikana, inova ndiyo hwaro hwaro hwekudzivirira neuroprotection.

Multi target neuroprotective mhedzisiro:

Deredza excitotoxicity: inhibit kusunungurwa kwakanyanya uye chepfu ye glutamate.

Antioxidant stress: inowedzera glutathione mazinga uye inobvisa mahara radicals.

Kuvandudza mitochondrial basa: kuchengetedza simba metabolism uye kuderedza sero apoptosis.

Kurudzira neurotransmitter synthesis: kuwedzera mazinga eacetylcholine, dopamine, nezvimwewo, kuvandudza tsinga conduction.

Deredza neuroinflammation: inhibit kusunungurwa kwepro-inflammatory cytokines.

Iyo meshini inoona kuti inofanirwa kunge iri basa rekutanga re "kupindira kwekutanga uye kuchengetedzwa kwakasimba", pane kungobatsira pakuzorodza zviratidzo. .

Kuunganidzirwa kwehumbowo hwepamusoro-hwakavakirwa humbowo (kuputsa nekufungidzira kwe "mubatsiri"):

Acute ischemic sitiroko (AIS):

ICTUS kudzidza (2012): Kunyange zvazvo magumo ekupedzisira akanga asina kunaka, zvikamu zvakafanotemerwa (zvine mwero kusvika kune zvakanyanya sitiroko, kurapwa kwepakutanga) zvakaratidza zvakakosha, zvichiratidza kuti nguva yekurapa uye kusarudzwa kwevanhu kwakakosha.

ECCO 2 kudzidza (2023): hombe RCT yakaitwa muChinese huwandu (3947 AIS varwere vanosanganisirwa). Zvigumisiro zvakaratidza kuti pamusana pe intravenous thrombolysis uye / kana endovascular treatment, kare (mumaawa makumi maviri nemana mushure mekutanga) kushandiswa kweropa kwephosphatidylcholine kwemazuva gumi nemana kwakawedzera zvakanyanya chikamu chemazuva makumi mapfumbamwe ekuzvimirira (mRS 0-1) (43.5% vs 40.0%), uye kuchengeteka kwaive kwakanaka. Simbisa kuita kwayo synergistic pahwaro hweyakajairwa reperfusion therapy. .

Multiple meta-analyses: tsigira kushanda kwayo mukuvandudza migumisiro yetsinga uye mararamiro ehupenyu hwezuva nezuva, kunyanya kutanga kurapwa mumatanho ekutanga ekutanga (

Traumatic Brain Injury (TBI):

Chidzidzo cheCOBRIT: Mhedzisiro yacho inokakavadzana, asi ongororo inotevera inoratidza kuti mapoka madiki (yepakati kusvika kune yakaoma TBI) anobatsirwa.

Kutsvagisa kwepasirese & meta-analysis: Zvidzidzo zvakawanda zvakaratidza kuti zvinogona kuvandudza mhedzisiro yetsinga uye kupora kwekuziva muvarwere veTBI.

Neurodegenerative zvirwere (pasi pekuongorora):

Vascular cognitive impairment (VCI) / vascular dementia (VaD): Zvidzidzo zvakaratidza kuti inogona kuvandudza basa rekuziva (kutarisa, kuurayiwa, ndangariro).

Chirwere cheAlzheimer (AD)/Parkinson's disease (PD): Sevanokwanisa kugadzirisa zvirwere, zvimwe zvidzidzo zvidiki zvinoratidza kuvandudzwa kwekuziva uye maitiro.

Tsvagiridzo mune mamwe minda senge glaucoma uye musana kukuvara kwakaratidza zvakare neuroprotective kugona.

2, Chinhu chakakosha chekuisa shanduko: kubva "mubatsiri" kuenda ku "core"

Kufambisa nguva yekurapa mberi (yakakosha kupindira kwe "goridhe nguva hwindo"):

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Kiyi kune neuroprotection iri mu 'kutanga'. Mushure mekukuvara kwehuropi (zvakadai sesitiroko, TBI), mhinduro yekukuvara kwekasi inotangwa maminetsi akati wandei kusvika maawa akati wandei gare gare.

Iyo nzira yekuita yephosphatidylcholine inotarisa kuti inofanira kushandiswa mumatanho ekutanga ekukuvara kwekukuvara kwekasi (senge mukati meawa 24 mushure mekurohwa kwesitiroko, pakutanga zviri nani) kuvhara nzira yekukuvadzwa uye kudzivirira njodzi dzeneural tissues kusvika pamwero mukuru unobvira. Izvi zvakasiyana zvachose kubva pachinyakare chinzvimbo che "rehabilitation adjuvant mushonga".

Kubudirira kweECCO 2 kutsvagisa kwakavakirwa padhizaini yepakutanga intravenous management protocol.

Iyo yakakosha nzvimbo yekurapa zano (yakasanganiswa nereperfusion therapy):

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Innovation in the treatment mode of acute ischemic stroke: The standard treatment is vascular recanalization (thrombolysis, thrombectomy), asi chikamu chikuru chevarwere vachiri nehutachiona husina kunaka mushure mekugadzirisazve (kukuvadzwazve, hapana reflow phenomenon, nezvimwewo).

Iyo neuroprotective mashandiro ephosphatidylcholine (kudzikamisa cell membrane, antioxidant, anti apoptotic) inogona kuzadzisa uye kuyananisa nereperfusion therapy, kuderedza kukuvara kwekuwedzera uye kuchengetedza uropi mushure mekudzokorora.

ECCO 2 tsvagiridzo yakasimbisa kukosha kwayo seyakakosha neuroprotective chikamu mu "vascular recanalization +" zano, haisati ichingova sarudzo yekuwedzera yekubatsira.

Kugonesa nzira dzekutonga (kutevera bioavailability):

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Oral phosphatidylcholine ine yakaderera bioavailability (

Intravenous jekiseni rinogona kupa yakakwira bioavailability, nekukurumidza kuwana inoshanda inoshanda zvinodhaka zveropa, uye kusangana nezvinodiwa zvekukurumidza neuroprotection muchikamu chakaoma.

Shanduko yakanangana ne "core" positioning inozoperekedzwa nekurudziro ye intravenous dosage mafomu ekushandiswa muchikamu chakaoma.

3, Kugadziridzwa kwegwaro / kubvumirana (kuratidza shanduko yekumisikidza)

China:

Iyo "Nhungamiro Yekudzivirira uye Kurapa KweSitroke muChina" nemamwe magwaro anoratidza maitiro ayo neuroprotective.

Zvichienderana nekubudirira kwemhedzisiro yekutsvagisa kweECCO 2, zvinotarisirwa kuti nhanho yekurudziro uye chinzvimbo chephosphatidylcholine (kunyanya intravenous formulations inoshandiswa muchikamu cheacute) mumirayiridzo yeChinese ichavandudzwa zvakanyanya mune ramangwana. .

International:

Mirayiridzo yeAHA/ASA muUnited States haisati yanyatso kukurudzirwa, asi yakavhurika kutsvagisa nezve neuroprotective agents.

Mimwe nhungamiro yenyika dzeEurope ine kumwe kuongorora kwakanaka kwephosphatidylcholine (seSpain, Portugal).

4. Kukosha kwekushandurwa kwekumisikidza kwekiriniki

Gadziridza zano rekurapa: Neuroprotection imbiru yakakosha yakaenzana mukurapwa kwekukuvara kwehuropi kwakanyanya sevascular recanalization.

Gadzirisa chirongwa chekurapa: Kurudzira iyo core combination therapy ye phosphatidylcholine (intravenous) seyakajairika kurapwa (senge thrombolysis / thrombectomy) mu hyperacute / acute chikamu chesitiroko / TBI nezvimwe zvirwere.

Kuvandudza fungidziro yevarwere: Kuburikidza nekutanga uye inoshanda neuroprotection, zvinotarisirwa kuwedzera kuvandudza mwero wekupona uye mashandiro ekudzoreredza nhanho yevarwere vane acute kukuvara kwehuropi, uye kuderedza hurema.

Kurudzira kutsvagisa uye danho rekusimudzira: Kurudzira zvimwe zvemhando yepamusoro zvidzidzo zvekiriniki uye ongorora mitsva yekuunza zvinodhaka regimens yeacute neuroprotection.

Pfupiso uye Outlook

Shanduko yephosphatidylcholine kubva ku "adjuvant drug" kuenda ku "core neuroprotective agent" mhedzisiro yekudzika tsvakiridzo yekutanga, kubudirira muhumbowo hwekiriniki (kunyanya ECCO 2 research), uye pfungwa dzakagadziridzwa dzekurapa. Hunhu hwayo huri mu:

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Kupindira kwepakutanga: Simbisa mishonga panguva yewindo regoridhe (acute phase / subacute nhanho yekutanga) apo cascade reaction yekukuvara kwetsinga inotanga.

Intravenous priority: Muchikamu chakaoma apo chiito chekukurumidza chinodiwa, intravenous administration ndiyo nzira inokosha yekuita mhedzisiro yekudzivirira.

Joint performance enhancement: Sechinhu chinonyanya kukosha chekudzivirira neuroprotection pahwaro hwevascular recanalization therapy (stroke) kana kurapa kwakazara (TBI), haisi bhonasi yakawedzerwa.

Iyi shanduko inoratidza kuzivikanwa patsva uye kuwedzera kwekukosha kwephosphatidylcholine mukurapa kwezvirwere zvetsinga, kunyanya mukurapa maitiro eacute ischemic stroke. Sechikamu chakakosha che "standard reperfusion therapy+core neuroprotection" zano, iri kuwedzera humbowo hwakasimba-hwakavakirwa rutsigiro uye kuzivikanwa kwekiriniki. Mune ramangwana, nekuvandudzwa kwekutsvagisa kwemhando yepamusoro uye zvigadziriso kune nhungamiro, nzvimbo yayo yepakati ichabatanidzwa zvakare.