Ukuma emtholampilo kwe-Citicoline kunenguquko ebalulekile ngempela, kancane kancane ishintsha isuka “emuthini we-adjuvant” wendabuko iye “kumenzeli owumgogodla we-neuroprotective”. Lolu shintsho alunasisekelo, kodwa lusekelwe ekuqoqweni okuqhubekayo kobufakazi bemithi esekelwe ebufakazini, ukuqonda okujulile kwendlela yokusebenza okuhloswe ngayo okuningi, nokuqashelwa okubalulekile "kwefasitela lesikhathi" ekwelapheni ukulimala okukhulu kwezinzwa. Okulandelayo yizisekelo eziyinhloko nokuhlaziya okusekela lolu shintsho:

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I-1, Amandla okushayela ayinhloko: Ubufakazi obunamandla obusuka kumshini kuya ekusebenzeni komtholampilo

Ukuhlolwa kabusha kwendlela yokwenza (ngale 'kosizo'):

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I-Membrane phospholipid core yokulungisa: I-Cytophosphatidylcholine iyisandulela esiqondile sokuhlanganiswa kwe-cell membrane phospholipids, njenge-phosphatidylcholine. Ukuwohloka kwe-Membrane phospholipid kuyisenzakalo sokulimala esibucayi sangaphambi kwesikhathi ngemva kwe-neuronal ischemia/hypoxia. I-Phosphatidylcholine ingakwazi ukwengeza ngokuqondile izinto zokwakha ze-phospholipid, ikhuthaze ukulungiswa nokuqina kwe-nerve cell membrane, okuyisisekelo esiyisisekelo se-neuroprotection.

Multi target neuroprotective effects:

Yehlisa i-excitotoxicity: vimbela ukukhululwa ngokweqile kanye nobuthi be-glutamate.

Ukucindezeleka kwe-Antioxidant: kwandisa amazinga e-glutathione futhi kususe ama-radicals mahhala.

Ukwenza ngcono umsebenzi we-mitochondrial: ukugcina amandla e-metabolism kanye nokunciphisa i-apoptosis yeseli.

Khuthaza ukuhlanganiswa kwe-neurotransmitter: ukwandisa amazinga e-acetylcholine, i-dopamine, njll., ngcono ukuqhutshwa kwezinzwa.

Yehlisa ukuvuvukala kwe-neuroinflammation: vimbela ukukhululwa kwama-cytokines ane-pro-inflammatory.

Indlela yokusebenza inquma ukuthi kufanele kube indima eyinhloko "yokungenelela kusenesikhathi nokuvikela okusebenzayo", kunokuba kube nje insiza yokukhululeka kwezimpawu. .

Ukuqoqwa kobufakazi obusekwe ebufakazini bekhwalithi ephezulu (ukwephula umbono "we-axiliary"):

I-Acute ischemic stroke (AIS):

Ucwaningo lwe-ICTUS (2012): Nakuba isiphetho esiyinhloko sasingesihle, ama-subgroups anqunywe kusengaphambili (ukushaywa unhlangothi okumaphakathi kuya kobuhlungu, ukwelashwa kwangaphambi kwesikhathi) abonise izinzuzo ezibalulekile, okuphakamisa ukuthi isikhathi sokwelashwa nokukhethwa kwabantu kubalulekile.

Ucwaningo lwe-ECCO 2 (2023): i-RCT enkulu eyenziwa kubantu baseShayina (iziguli ezingama-3947 AIS zifakiwe). Imiphumela yabonisa ukuthi ngesisekelo se-thrombolysis ye-intravenous kanye/noma ukwelashwa kwe-endovascular, kusenesikhathi (phakathi kwamahora angu-24 ngemva kokuqala) ukusetshenziswa komthambo we-phosphatidylcholine izinsuku ezingu-14 kwandisa kakhulu ingxenye yezinsuku ezingama-90 zokuzimela (mRS 0-1) (43.5% vs 40.0%), nokuphepha kwakukuhle. Qinisekisa umthelela wayo we-synergistic ngesisekelo sokwelashwa okujwayelekile kokubuyisela kabusha. .

Ukuhlaziywa kwe-meta okuningi: kusekela ukusebenza kahle kwayo ekuthuthukiseni imiphumela yezinzwa kanye namakhono okuphila kwansuku zonke, ikakhulukazi ukuqala ukwelashwa ezinyathelweni zokuqala zokuqala (

I-Traumatic Brain Injury (TBI):

Ucwaningo lwe-COBRIT: Imiphumela iyimpikiswano, kodwa ukuhlaziywa okulandelayo kuphakamisa ukuthi ama-subgroups athile (i-TBI emaphakathi ukuya kokuqina) ayazuza.

Ucwaningo lomhlaba wangempela nokuhlaziywa kwemeta: Ucwaningo oluningi lubonise ukuthi lungathuthukisa imiphumela yemizwa kanye nokululama kokwazi ezigulini ze-TBI.

Izifo ze-Neurodeergenerative (ngaphansi kokuhlolwa):

I-Vascular cognitive impairment (VCI)/i-vascular dementia (VaD): Ucwaningo luye lwabonisa ukuthi lungathuthukisa umsebenzi wokuqonda (ukunaka, ukubulawa, inkumbulo).

Isifo i-Alzheimer's (AD)/Parkinson's (PD): Njengama-ejenti angahle aguqule izifo, ucwaningo oluthile oluncane luphakamisa ukuthuthukiswa kwengqondo nokuziphatha.

Ucwaningo kwezinye izinkambu ezifana ne-glaucoma kanye nokulimala komgogodla nakho kubonise amandla e-neuroprotective.

2, Iphuzu eliyisihluthulelo lokumisa ukuguqulwa: ukusuka "kumsizi" kuya "kumgogodla"

Ukuyisa isikhathi sokwelashwa phambili (ukungenelela okuyinhloko "kwewindi lesikhathi segolide"):

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Ukhiye wokuvikela i-neuroprotection ulele 'ngaphambi kwesikhathi'. Ngemuva kokulimala kobuchopho (okufana nokushaywa unhlangothi, i-TBI), impendulo yokulimala kwe-cascade iqaliswa imizuzu embalwa kuya emahoreni ambalwa kamuva.

Indlela yokusebenza ye-phosphatidylcholine inquma ukuthi kufanele isetshenziswe ezigabeni zokuqala zokusabela kwe-cascade yokulimala (njengamahora angu-24 ngemva kokuqala kwe-stroke, ngaphambi kwesikhathi okungcono) ukuvimba indlela yokulimala nokuvikela izicubu ze-neural ezisengozini kakhulu ngangokunokwenzeka. Lokhu kuhluke ngokuphelele ekumisweni kwendabuko "kwemithi yokuvuselela i-adjuvant".

Impumelelo yocwaningo lwe-ECCO 2 isuselwe ekwakhiweni kwezinqubo zokuphatha ezifakwa emthanjeni kusenesikhathi.

Isikhundla esiyinhloko sesu lokwelapha (kuhlanganiswe nokwelapha ngokuphindaphinda):

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Ukuqamba okusha endleleni yokwelapha ye-acute ischemic stroke: Ukwelashwa okujwayelekile ukuvuselelwa kwemithambo (i-thrombolysis, i-thrombectomy), kodwa ingxenye enkulu yeziguli isenokubikezela okubi ngemva kokuvuselelwa kabusha (ukulimala kabusha, akukho mkhuba wokugeleza kabusha, njll.).

I-neuroprotective mechanism ye-phosphatidylcholine (i-stabilizing cell membrane, i-antioxidant, i-anti apoptotic) ingahambisana futhi ihambisane nokwelashwa kokubuyisela kabusha, ukunciphisa ukulimala kokubuyisela futhi ivikele izicubu zobuchopho ngemva kokuphindwaphindwa.

Ucwaningo lwe-ECCO 2 luqinisekise inani lalo njengengxenye eyinhloko ye-neuroprotective kucebo "lokuvuselela imithambo+", akuseyona nje into engeziwe yokuzikhethela.

Ukwenziwa ngcono kwemizila yokuphatha (ukuphishekela i-bioavailability):

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I-Oral phosphatidylcholine ine-bioavailability ephansi (

Umjovo we-intravenous unganikeza i-bioavailability ephezulu, ufinyelele ngokushesha ukugxila kwezidakamizwa zegazi, futhi uhlangabezane nezidingo ze-neuroprotection esheshayo esigabeni esibucayi.

Ukushintshela ekubekeni "okuyisisekelo" nakanjani kuzohambisana nesincomo samafomu omthamo ofakwa emthanjeni ukuze asetshenziswe esigabeni esibucayi.

3, Ukubuyekezwa kwemihlahlandlela/ukuvumelana (okubonisa ukushintsha kokuma)

I-China:

"Iziqondiso Zokuvimbela Nokwelashwa Kwe-Stroke E-China" kanye neminye imibhalo ibonise umphumela wayo wokuvikela i-neuroprotective.

Ngokusekelwe emiphumeleni ephumelelayo yocwaningo lwe-ECCO 2, kulindeleke ukuthi izinga lokuncoma kanye nokuma kwe-phosphatidylcholine (ikakhulukazi ukwakheka kwe-intravenous okusetshenziswe esigabeni esibucayi) kuzinkombandlela zaseShayina kuzothuthukiswa kakhulu esikhathini esizayo. .

Okwamazwe ngamazwe:

Imihlahlandlela ye-AHA/ASA e-United States ayikanconywa ngokusobala, kodwa ivulekele ucwaningo ngama-ajenti we-neuroprotective.

Eminye imihlahlandlela yezwe laseYurophu inokuhlola okuhle kakhulu kwe-phosphatidylcholine (njengeSpain, Portugal).

4. Ukubaluleka kokuguqulwa kokuma emtholampilo

Buyekeza umqondo wokwelapha: I-Neuroprotection iyinsika ebaluleke ngokulinganayo ekwelapheni ukulimala okukhulu kobuchopho njengokuvuselelwa kwemithambo.

Thuthukisa uhlelo lokwelapha: Thuthukisa ukwelapha okuhlangene okuyisisekelo kwe-phosphatidylcholine (intravenous) njengokwelashwa okujwayelekile (okufana ne-thrombolysis/thrombectomy) esigabeni se-hyperacute/acute se-stroke/TBI nezinye izifo.

Ukuthuthukisa ukubikezela kwesiguli: Ngokuvikela i-neuroprotection kusenesikhathi nangempumelelo, kulindeleke ukuthi kuthuthukiswe izinga lokusinda kanye nezinga elisebenzayo lokululama leziguli ezinokulimala okukhulu kwengqondo, nokunciphisa ukukhubazeka.

Thuthukisa ucwaningo nesiqondiso sentuthuko: Nyusa izifundo zomtholampilo zekhwalithi ephezulu futhi uhlole izindlela ezintsha zokulethwa kwezidakamizwa ukuze uthole i-acute neuroprotection.

Isifinyezo kanye ne-Outlook

Ukuguqulwa kwe-phosphatidylcholine isuka "kumuthi we-adjuvant" ibe "i-agent ye-neuroprotective eyinhloko" kuwumphumela wokujula kocwaningo oluyisisekelo, impumelelo ebufakazini bomtholampilo (ikakhulukazi ucwaningo lwe-ECCO 2), kanye nemiqondo yokwelashwa ebuyekeziwe. Umongo wayo uku:

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Ukungenelela kwangaphambi kwesikhathi: Gcizelela imithi ngesikhathi sewindi lesikhathi segolide (isigaba esibuhlungu/isigaba sokuqala esiphansi) lapho kuqaliswa ukusabela kwe-cascade yokulimala kwezinzwa.

Ukubaluleka kokungena emthanjeni: Esigabeni esibucayi lapho kudingeka khona isinyathelo esisheshayo, ukuphathwa ngomthambo kuyindlela eyinhloko yokukhipha imiphumela yokuvikela eyinhloko.

Ukuthuthukiswa kokusebenza kahle okuhlanganyelwe: Njengengxenye esemqoka ebalulekile yokuvikela i-neuroprotection ngesisekelo sokwelashwa kabusha kwe-vascular recanalization (stroke) noma ukwelashwa okuphelele (TBI), akuyona ibhonasi eyengeziwe.

Lolu shintsho lubonisa ukuqashelwa okuvuselelwe kanye nokuthuthukiswa kokubaluleka kwe-phosphatidylcholine ekwelapheni izifo ze-neurological, ikakhulukazi iphethini yokwelapha ye-acute ischemic stroke. Njengengxenye ebalulekile yesu elithi "standard reperfusion therapy+core neuroprotection", ithola ukwesekwa okuqinile okusekelwe ebufakazini kanye nokuqashelwa komtholampilo. Ngokuzayo, ngokuthuthukiswa kocwaningo lwekhwalithi ephezulu kanye nezibuyekezo zezinkombandlela, isikhundla salo esiyinhloko sizophinde sihlanganiswe.