Ukuma kweklinikhi yeCiticoline ngenene kuyenzeka inguqu ebalulekileyo, ngokuthe ngcembe isuka kwi "adjuvant drug" yemveli ukuya kwi "core neuroprotective agent". Olu tshintsho alunasiseko, kodwa lusekelwe ekuqokeleleni okuqhubekayo kobungqina beyeza obusekelwe kubungqina, ukuqonda okunzulu kwendlela yokwenza izinto ezininzi ekujoliswe kuzo, kunye nokuqatshelwa okubalulekileyo "kwefestile yexesha" kunyango lokulimala kwe-nerve acute. Ezi zilandelayo ziziseko ezingundoqo kunye nohlalutyo oluxhasa le nguqu:

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I-1, Amandla okuqhuba angundoqo: Ubungqina obunamandla ukusuka kwindlela ukuya kwikliniki yokusebenza

Ukuhlolwa kwakhona kwendlela yokwenza (ngaphaya 'koncedo'):

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Undoqo wokulungisa i-Membrane phospholipid: I-Cytophosphatidylcholine yi-precursor ethe ngqo kwi-synthesis ye-cell membrane phospholipids, njenge-phosphatidylcholine. Ukuthotywa kweMembrane phospholipid sisiganeko sokuqala sokwenzakala esibalulekileyo emva kwe-neuronal ischemia/hypoxia. I-Phosphatidylcholine inokongeza ngokuthe ngqo izinto ze-phospholipid synthesis, ikhuthaze ukulungiswa kwe-membrane ye-nerve eyonakalisiweyo kunye nokuzinza, eyona siseko esisisiseko sokukhusela i-neuroprotection.

Iziphumo ezininzi ezijoliswe kwi-neuroprotective:

Ukunciphisa i-excitotoxicity: inqanda ukukhululwa ngokugqithiseleyo kunye netyhefu ye-glutamate.

Uxinzelelo lwe-Antioxidant: kwandisa amanqanaba e-glutathione kunye nokucima i-radicals yamahhala.

Ukuphucula umsebenzi we-mitochondrial: ukugcina amandla e-metabolism kunye nokunciphisa i-apoptosis yeseli.

Ukukhuthaza i-neurotransmitter synthesis: ukwandisa amanqanaba e-acetylcholine, i-dopamine, njl., ukuphucula i-nerve conduction.

Ukunciphisa i-neuroinflammation: inqanda ukukhululwa kwe-cytokines e-pro-inflammatory.

Indlela yokusebenza imisela ukuba kufanele ibe yeyona ndima ingundoqo "yongenelelo kwangethuba kunye nokhuseleko olusebenzayo", endaweni nje yokuncedisa ekupheliseni iimpawu. ...

Ukuqokelelwa kobungqina obuphezulu obusekwe kubungqina (ukugqobhoza imbonakalo "yoncedo"):

I-Acute ischemic stroke (AIS):

Uphononongo lwe-ICTUS (2012): Nangona isiphelo esiphambili sasingalunganga, ii-subgroups ezinqunywe kwangaphambili (i-moderation ukuya kwi-stroke enzima, unyango lwangethuba) lubonise inzuzo ebalulekileyo, ebonisa ukuba ixesha lonyango kunye nokukhethwa kwabantu kubalulekile.

Uphononongo lwe-ECCO 2 (2023): i-RCT enkulu eyenziwa ngabantu baseTshayina (izigulane ze-AIS ezingama-3947 zibandakanyiwe). Iziphumo zibonise ukuba ngesiseko se-thrombolysis ye-intravenous kunye / okanye unyango lwe-endovascular, ekuqaleni (ngaphakathi kweeyure ze-24 emva kokuqala) ukusetyenziswa kwe-intravenous ye-phosphatidylcholine kwiintsuku ze-14 kwandisa kakhulu umlinganiselo weentsuku ze-90 zokuzimela komsebenzi (mRS 0-1) (43.5% vs 40.0%), kwaye ukhuseleko lwalulungile. Qinisekisa isiphumo sayo se-synergistic ngokwesiseko sonyango oluqhelekileyo lokubuyisela kwakhona. ...

Uhlalutyo lweemeta ezininzi: ukuxhasa ukusebenza kwayo ekuphuculeni iziphumo ze-neurological kunye nobuchule bokuphila bemihla ngemihla, ngakumbi ukuqala unyango kwizigaba zokuqala zokuqala (

Ukwenzakala kwiBrain Traumatic (TBI):

Uphononongo lwe-COBRIT: Iziphumo ziphikisana, kodwa uhlalutyo olulandelayo lubonisa ukuba ama-subgroups athile (ephakathi ukuya kwi-TBI enzima) inzuzo.

Uphando lwehlabathi lokwenyani kunye nohlalutyo lwemeta: Uphononongo oluninzi lubonise ukuba lunokuphucula iziphumo ze-neurological kunye nokuvuselelwa kwengqondo kwizigulana ze-TBI.

Izifo ze-Neurodeergenerative (phantsi kokuhlolwa):

I-Vascular cognitive impairment (VCI) / i-vascular dementia (VaD): Uphononongo lubonise ukuba lunokuphucula umsebenzi wokuqonda (ingqalelo, ukubulawa, imemori).

Isifo sika-Alzheimer (AD)/Isifo sika-Parkinson (PD): Njengee-arhente zokuguqula izifo, ezinye izifundo ezincinci zibonisa ukuphuculwa kwengqondo kunye nokuziphatha.

Uphando kwezinye iindawo ezifana ne-glaucoma kunye nokulimala kwentambo yomgogodla kuye kwabonisa amandla e-neuroprotective.

2, Inqaku eliphambili lokumisa inguqu: ukusuka "kwi-axiliary" ukuya "core"

Ukuqhubela phambili ixesha lonyango (ungenelelo olungundoqo "lwefestile yexesha legolide"):

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Isitshixo sokhuseleko lwemithambo-luvo silele 'kwangoko'. Emva kokulimala kwengqondo (njenge-stroke, i-TBI), impendulo yokulimala kwe-cascade iqaliswa imizuzu emininzi ukuya kwiiyure ezininzi kamva.

Indlela yokusebenza ye-phosphatidylcholine inquma ukuba ifanele isetyenziswe kwizigaba zokuqala zokulimala kwe-cascade reaction (ezifana neeyure ze-24 emva kokuqala kwe-stroke, kwangaphambili ngcono) ukuvala indlela yokulimala kunye nokukhusela izicubu ze-neural ezisengozini ukuya kwinqanaba elikhulu kunokwenzeka. Oku kwahluke ngokupheleleyo ekubekweni kwemveli "yeyeza le-adjuvant rehabilitation".

Impumelelo yophando lwe-ECCO 2 isekwe kuyilo lweprothokholi zolawulo lwakwangoko.

Eyona ndawo ingundoqo yesicwangciso sonyango (idityaniswe nonyango lokuphinda lusetyenziswe):

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Ukutsha kwindlela yonyango ye-acute ischemic stroke: Unyango oluqhelekileyo luhlaziyo lwe-vascular (thrombolysis, thrombectomy), kodwa inani elikhulu lezigulana zisene-prognosis embi emva kokuhlaziywa kwakhona (ukulimala ngokutsha, akukho nto yokubuyisela, njl.).

Inkqubo ye-neuroprotective ye-phosphatidylcholine (ukuzinzisa i-membrane yeseli, i-antioxidant, i-anti apoptotic) inokuncedisana kunye nokudibanisa kunye nonyango lokubuyisela kwakhona, ukunciphisa ukwenzakala kwakhona kunye nokukhusela izicubu zobuchopho emva kokuphindaphinda.

Uphando lwe-ECCO 2 luqinisekisile ixabiso layo njengenxalenye engundoqo ye-neuroprotective kwisicwangciso se-"vascular recanalization +" , akusekho nje ukongezwa kokuncedisa okukhethiweyo.

Ukuphucula iindlela zolawulo (ukulandela i-bioavailability):

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I-phosphatidylcholine yomlomo ine-bioavailability ephantsi (

Inaliti ye-Intravenous inokubonelela nge-bioavailability ephezulu, ukufezekisa ngokukhawuleza ukugxila kweyeza legazi, kunye nokuhlangabezana neemfuno zokhuseleko olukhawulezayo lwe-neuroprotection kwisigaba esinzima.

Ukutshintshela kwindawo "engundoqo" ngokuqinisekileyo kuya kukhatshwa sisindululo seefom zedosi emithanjeni ukuze zisetyenziswe kwisigaba esinzima.

3, Uhlaziyo lwezikhokelo/imvumelwano (ebonisa utshintsho kwindawo)

eTshayina:

"Izikhokelo zoThintelo kunye noNyango lwe-Stroke e-China" kunye namanye amaxwebhu abonise umphumo wayo we-neuroprotective.

Ngokusekelwe kwiziphumo eziphumeleleyo zophando lwe-ECCO 2, kulindeleke ukuba inqanaba lokucebisa kunye nokubeka i-phosphatidylcholine (ingakumbi i-intravenous formulations esetyenziswa kwisigaba esibuhlungu) kwizikhokelo zaseTshayina ziya kuphuculwa kakhulu kwixesha elizayo. ...

Amazwe ngamazwe:

Izikhokelo ze-AHA / ASA e-United States azikacebisi ngokucacileyo, kodwa zivulelekile kuphando malunga ne-neuroprotective agents.

Ezinye izikhokelo zelizwe laseYurophu zinovavanyo oluhle ngakumbi lwe-phosphatidylcholine (efana neSpain, Portugal).

I-4, Ukubaluleka kwenguqu yokubeka ikliniki

Hlaziya ingcamango yonyango: I-Neuroprotection yintsika ebaluleke ngokulinganayo kunyango lokulimala kwengqondo ebukhali njenge-vascular recanalization.

Ukulungiselela isicwangciso sonyango: Ukukhuthaza unyango oluphambili lwe-phosphatidylcholine (intravenous) njengonyango oluqhelekileyo (njenge-thrombolysis / thrombectomy) kwi-hyperacute / acute phase of stroke / TBI kunye nezinye izifo.

Ukuphucula i-prognosis yesigulana: Ngokusetyenziswa kwe-neuroprotection kwangethuba nangempumelelo, kulindeleke ukuba kuphuculwe ngakumbi izinga lokusinda kunye nenqanaba lokubuyisela ukusebenza kwezigulana ezinokwenzakala okukhulu kwengqondo, kunye nokunciphisa ukukhubazeka.

Khuthaza uphando kunye nomkhombandlela wophuhliso: Ukukhuthaza izifundo zeklinikhi ezikumgangatho ophezulu kwaye uphonononge iirejimeni zokuhanjiswa kweziyobisi ezitsha zokhuseleko lwe-neuroprotection.

Isishwankathelo kunye ne-Outlook

Ukuguqulwa kwe-phosphatidylcholine kwi-"adjuvant drug" ukuya kwi-"core neuroprotective agent" yisiphumo sophando olusisiseko olunzulu, ukuphumelela kobungqina bekliniki (ingakumbi uphando lwe-ECCO 2), kunye neengcamango zonyango ezihlaziyiweyo. Undoqo wayo uku:

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Ukungenelela kwangethuba: Gxininisa amayeza ngexesha lefestile yexesha legolide (isigaba esibuhlungu / i-subacute yokuqala) xa i-cascade reaction ye-nerve iqaliswa.

I-intravenous priority: Kwinqanaba elibukhali apho kufuneka khona isenzo esikhawulezayo, ukulawulwa kwe-intravenous yindlela ephambili yokukhupha iziphumo ezingundoqo zokukhusela.

Ukongezwa kobuchule obudibeneyo: Njengenxalenye engundoqo efunekayo yokukhusela i-neuroprotection kwisiseko sonyango lwe-vascular recanalization (stroke) okanye unyango olubanzi (TBI), akusiyo ibhonasi eyongezelelweyo.

Olu tshintsho lubonisa ukuqaphela ngokutsha kunye nokuphuculwa kwexabiso le-phosphatidylcholine kunyango lwezifo ze-neurological, ngokukodwa kwindlela yonyango ye-acute ischemic stroke. Njengenxalenye ebalulekileyo yesicwangciso "sonyango oluqhelekileyo lwe-reperfusion+core neuroprotection", lufumana inkxaso ethe kratya esekwe kubungqina kunye nokuqondwa kwezonyango. Kwixesha elizayo, ngophuhliso lophando olukumgangatho ophezulu ngakumbi kunye nohlaziyo lwezikhokelo, indawo yalo ephambili iya kuhlanganiswa ngakumbi.