Boemo ba kliniki ba Citicoline bo ntse bo le boemong ba phetoho ea bohlokoa, butle-butle bo fetoha ho tloha "sethethefatsi se thusang" ho ea ho "sehlahisoa sa mantlha sa neuroprotective". Phetoho ena ha e na motheo, empa e ipapisitse le ho bokellana ho tsoelang pele ha bopaki ba meriana e thehiloeng bopaking, kutloisiso e tebileng ea mekhoa ea eona e mengata ea ts'ebetso, le temoho e tebileng ea "fensetere ea nako" ea phekolo ea kotsi e matla ea methapo. Lintlha tse latelang ke tsa bohlokoa le litlhahlobo tse t?ehetsang phetoho ena:

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1, Matla a ho khanna a mantlha: Bopaki bo matla ho tloha mochining ho ea ho boikoetliso ba bongaka

Tlhahlobo e ncha ea mokhoa oa ts'ebetso (ho feta 'thuso'):

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Mokotla oa tokiso ea Membrane phospholipid: Cytophosphatidylcholine ke selelekela se tobileng bakeng sa motsoako oa lisele tsa phospholipids, tse kang phosphatidylcholine. Ho senyeha ha Membrane phospholipid ke ketsahalo ea pele ea kotsi e mpe ka mor'a neuronal ischemia/hypoxia. Phosphatidylcholine e ka tlatselletsa ka kotloloho lisebelisoa tsa endogenous phospholipid synthesis, ea khothaletsa tokiso le botsitso ba methapo ea methapo e senyehileng, e leng motheo oa mantlha oa ts'ireletso ea methapo.

Litlamorao tse ngata tsa neuroprotective:

Fokotsa excitotoxicity: thibela ho lokolloa ho feteletseng le chefo ea glutamate.

Antioxidant khatello ea maikutlo: e eketsa maemo a glutathione mme e hlakola li-radicals tsa mahala.

Ho ntlafatsa ts'ebetso ea mitochondrial: ho boloka metabolism ea matla le ho fokotsa apoptosis ea lisele.

Khothalletsa motsoako oa li-neurotransmitter: eketsa maemo a acetylcholine, dopamine, joalo-joalo, ho ntlafatsa tsamaiso ea methapo.

Fokotsa neuroinflammation: thibela ho lokolloa ha li-cytokine tsa pro-inflammatory.

Mochini o etsa qeto ea hore e lokela ho ba karolo ea mantlha ea "ho kena lipakeng kapele le ts'ireletso e sebetsang", ho fapana le ho thusa feela ho imolla mat?oao. "

Ho bokella bopaki ba boleng bo phahameng bo thehiloeng bopaking (ho senya maikutlo a "mothusi"):

Acute ischemic stroke (AIS):

Thuto ea ICTUS (2012): Le hoja qetello e ka sehloohong e ne e le mpe, lihlopha tse seng kae tse neng li reriloe esale pele (setorouku se itekanetseng ho isa ho se matla, phekolo ea pele) se bont?itse melemo e mengata, e fana ka maikutlo a hore nako ea phekolo le khetho ea baahi ke tsa bohlokoa.

Thuto ea ECCO 2 (2023): RCT e kholo e etsoang ho baahi ba Chaena (bakuli ba 3947 AIS ba kenyelelitsoe). Liphello li bont?itse hore motheong oa thrombolysis ea methapo le / kapa phekolo ea endovascular, pele (ka mor'a lihora tse 24 ka mor'a ho qala) t?ebeliso ea methapo ea phosphatidylcholine ka matsatsi a 14 e ile ea eketsa haholo karolo ea matsatsi a 90 a boipuso (mRS 0-1) (43.5% vs 40.0%). Netefatsa ts'ebetso ea eona ea synergistic motheong oa kalafo e tloaelehileng ea reperfusion. "

Litlhahlobo tse ngata tsa meta: t?ehetsa katleho ea eona ho ntlafatsa liphello tsa methapo ea kutlo le bokhoni ba bophelo ba letsatsi le leng le le leng, haholo-holo ho qala kalafo ka mekhahlelo ea pele ea ho qala (

Kotsi ea Boko e Tloaelehileng (TBI):

Thuto ea COBRIT: Liphetho li na le likhang, empa tlhahlobo e latelang e fana ka maikutlo a hore lihlopha tse itseng (TBI e itekanetseng ho isa ho e matla) e rua molemo.

Patlisiso ea 'nete ea lefats'e le tlhahlobo ea meta: Lithuto tse ngata li bonts'itse hore e ka ntlafatsa liphetho tsa methapo ea kutlo le ho hlaphoheloa kelellong ho bakuli ba TBI.

Mafu a Neurodegenerative (a ntse a hlahlojoa):

Vascular cognitive impairment (VCI) / vascular dementia (VaD): Liphuputso li bont?itse hore li ka ntlafatsa ts'ebetso ea kelello (tlhokomelo, ts'ebetso, mohopolo).

Lefu la Alzheimer's (AD)/Parkinson's disease (PD): Joalo ka mahlahana a ka fetolang mafu, liphuputso tse ling tse nyane li fana ka maikutlo a ntlafatso ea kutloisiso le boit?oaro.

Lipatlisiso likarolong tse ling tse kang glaucoma le lesapo la mokokotlo le tsona li bont?itse bokhoni ba ho sireletsa methapo ea kutlo.

2, Ntlha ea bohlokoa ea ho beha phetoho: ho tloha "tlatsetso" ho ea ho "core"

Ho fetisetsa nako ea kalafo pele (ts'ebetso ea mantlha ea "fensetere ea nako ea khauta"):

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Senotlolo sa ts'ireletso ea methapo e lutse 'pele'. Ka mor'a kotsi ea boko (e kang stroke, TBI), karabo ea kotsi ea cascade e qalisoa metsotso e 'maloa ho isa lihora tse' maloa hamorao.

Mokhoa oa ts'ebetso oa phosphatidylcholine o etsa qeto ea hore o lokela ho sebelisoa matsatsing a pele a ts'oaetso ea kotsi ea kotsi (e kang ka hare ho lihora tsa 24 ka mor'a hore stroke se qale, pele ho moo ho molemo) ho thibela tsela ea kotsi le ho sireletsa lisele tsa neural tse kotsing ka hohle kamoo ho ka khonehang. Sena se fapane ka ho feletseng le boemo ba setso sa "rehabilitation adjuvant medicine".

Katleho ea lipatlisiso tsa ECCO 2 e ipapisitse le moralo oa liprothokholo tsa pele tsa tsamaiso ea methapo.

Boemo ba mantlha ba leano la kalafo (ho kopantsoe le pheko ea pheko):

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Mokhoa o mocha oa kalafo ea lefu la ischemic stroke: Mokhoa o tloaelehileng oa kalafo ke ho nchafatsa methapo ea mali (thrombolysis, thrombectomy), empa palo e kholo ea bakuli e ntse e e-na le bofokoli bo bobe ka mor'a ho nchafatsoa (ho lematsoa hape, ha ho na ts'ebetso ea ho phalla, joalo-joalo).

Mochini oa neuroprotective oa phosphatidylcholine (ho tsitsisa lisele tsa lisele, antioxidant, anti apoptotic) o ka tlatselletsa le ho sebelisana le kalafo ea reperfusion, ho fokotsa kotsi ea ho khutlisetsoa morao le ho sireletsa lisele tsa boko ka mor'a ho phetoa hape.

Patlisiso ea ECCO 2 e netefalitse boleng ba eona e le karolo ea mantlha ea methapo ea kutlo leanong la "vascular recanalization +", ha e sa le tlatsetso ea boikhethelo feela.

Ntlafatso ea litsela tsa tsamaiso (ho phehella bioavailability):

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Oral phosphatidylcholine e na le bioavailability e tlase (

Ente e kenang ka har'a methapo e ka fana ka bioavailability e phahameng, ea fihlella ka potlako khatello ea meriana ea mali, 'me ea fihlela litlhoko tsa ts'ireletso ea methapo e potlakileng mohatong o hlobaetsang.

Phetoho e lebisang boemong ba "core" e tla tsamaellana le khothaletso ea mefuta ea litekanyetso tsa methapo bakeng sa ho sebelisoa maemong a hlobaetsang.

3, Nchafatso ea litataiso / tumellano (e bonts'ang phetoho ea maemo)

China:

"Litaelo tsa Thibelo le Kalafo ea Stroke Chaena" le litokomane tse ling li bont?itse phello ea eona ea ho sireletsa methapo ea kutlo.

Ho ipapisitsoe le liphetho tsa katleho ea lipatlisiso tsa ECCO 2, ho lebelletsoe hore boemo ba khothaletso le boemo ba phosphatidylcholine (haholo-holo li-intravenous formulations tse sebelisoang karolong e bohloko) ho litataiso tsa China li tla ntlafatsoa haholo nakong e tlang. "

Machabeng:

Litaelo tsa AHA/ASA United States ha li e-so bue ka ho hlaka, empa li bulehile ho etsa lipatlisiso ka li-neuroprotective agents.

Litaelo tse ling tsa linaha tsa Europe li na le tlhahlobo e ntle ea phosphatidylcholine (joalo ka Spain, Portugal).

4. Bohlokoa ba phetoho ea boemo ba kliniki

Ntlafatsa mohopolo oa kalafo: Neuroprotection ke t?iea ea bohlokoa ka mokhoa o ts'oanang kalafong ea kotsi e mpe ea boko joalo ka ho nchafatsa methapo ea mali.

Ntlafatsa moralo oa phekolo: Khothalletsa phekolo ea mantlha ea phosphatidylcholine (intravenous) e le phekolo e tloaelehileng (e kang thrombolysis / thrombectomy) karolong ea hyperacute / acute ea stroke / TBI le mafu a mang.

Ho ntlafatsa boemo ba mokuli: Ka ts'ireletso ea methapo ea pele le e sebetsang, ho lebelletsoe ho ntlafatsa le ho feta lebelo la ho pholoha le boemo ba ts'ebetso ea ho hlaphoheloa ha bakuli ba nang le kotsi e mpe ea boko, le ho fokotsa kholofalo.

Khothaletsa tataiso ea lipatlisiso le nts'etsopele: Khothaletsa lithuto tsa bongaka tsa boemo bo holimo le ho hlahloba mekhoa e mecha ea phepelo ea lithethefatsi bakeng sa ts'ireletso e matla ea methapo.

Kakaretso le Outlook

Phetoho ea phosphatidylcholine ho tloha ho "adjuvant drug" ho "core protective agent" ke phello ea ho teba ha lipatlisiso tsa motheo, tsoelo-pele ea bopaki ba kliniki (haholo-holo lipatlisiso tsa ECCO 2), le likhopolo tse nchafalitsoeng tsa phekolo. Moko oa eona o ka ho:

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Ho kenella pele ho nako: Totobatsa meriana nakong ea fensetere ea nako ea khauta (acute phase / subacute early stage) ha ts'ebetso ea cascade ea kotsi ea methapo e qalisoa.

Ntho ea bohlokoa ka ho fetisisa ka har'a methapo: Boemong bo matla boo ho hlokahalang ho nka khato ka potlako, tsamaiso ea methapo ke tsela ea bohlokoa ea ho fana ka liphello tsa mantlha tsa t?ireletso.

Ntlafatso ea ts'ebetso e kopaneng: Joalo ka karolo ea bohlokoa ea ts'ireletso ea methapo motheong oa vascular recanalization therapy (stroke) kapa kalafo e felletseng (TBI), ha se bonase e ekelitsoeng.

Phetoho ena e t?oaea temoho e nchafalitsoeng le ntlafatso ea boleng ba phosphatidylcholine kalafong ea mafu a methapo ea kutlo, haholo-holo mokhoeng oa kalafo oa lefu la ischemic stroke. E le karolo ea bohlokoa ea leano la "standard reperfusion therapy+core neuroprotection", e ntse e fumana t?ehetso e matla e thehiloeng ho bopaki le kananelo ea bongaka. Nakong e tlang, ka nts'etsopele ea lipatlisiso tsa boleng bo holimo le lintlafatso tsa litataiso, boemo ba eona ba mantlha bo tla kopanngoa le ho feta.