Effects of Edaravone on Muscle Atrophy and Locomotor Function in Patients with Ischemic Stroke
Effects of Edaravone on Muscle Atrophy and Locomotor Function in Patients with Ischemic Stroke
复制标题
依达拉奉对缺血性脑卒中患者肌肉萎缩和运动功能的影响
作者：
H. Naritomi;H. Moriwaki;N. Metoki;H. Nishimura;Y. Higashi;Yasumasa Yamamoto;H. Yuasa;H. Oe;Kortaro Tanaka;Kozue Saito;Y. Terayama;T. Oda;N. Tanahashi;H. Kondo
背景与目的：严重下肢瘫痪的中风患者在急性期和亚急性期经常卧床不起，这增加了慢性期废用性肌肉萎缩的风险。迄今为止的证据表明，氧化应激在废用性肌肉萎缩的机制中起着重要作用。因此，本研究的目的是确定急性卒中后长期使用依达拉奉进行自由基清除剂治疗是否可以预防慢性期废用性肌肉萎缩的进展并改善腿部运动功能。
方法：这项随机对照的初步研究在日本19个急性卒中和康复中心进行。47例在发病24小时内入院的至少有腿部运动无力的缺血性卒中患者被随机分配接受依达拉奉30 mg每日2次持续静脉输注3天（短期组）或10-14天（长期组）。该研究的主要终点包括腿部废用性肌肉萎缩的程度，如通过膝上15 cm处的股肌周长相对于基线的百分比变化所测量的，以及腿部运动功能的改善，如通过中风发作后3个月超过10 m的最大步行速度所评估的。
结果：共有41例患者完成了3个月的随访（短期组21例，长期组20例）。入院时，两个治疗组之间的中风严重程度或下肢轻瘫等级没有显著差异。中风发作后3周废用性肌肉萎缩的程度和步态障碍的发生率在短期和长期组之间也相似。然而，卒中发作后3个月，长期治疗组和短期治疗组的轻瘫和非轻瘫下肢废用性肌肉萎缩的严重程度显著低于短期治疗组（3.6±5.9%和1.5±6.0% vs 8.3±5.2%和5.7±6.4%; p<0.01和p<0.05）。此外，在10 m距离内，长期组的最大步行速度显著更高（98±67 vs 54±55 cm/sec; p<0.05）。
结论：依达拉奉治疗长达14天，抑制废用性肌肉萎缩的进展，并改善腿部运动功能，在更大程度上比短期治疗急性中风患者。这表明，长期依达拉奉治疗可通过提供改善慢性期功能结局的肌保护作用来改善卒中的管理。
AbstractBackground and Objective: Stroke patients with severe leg paralysis are often bedridden in the acute and subacute phase, which increases the risk of disuse muscle atrophy in the chronic phase. The evidence to date indicates that oxidative stress plays an important role in the mechanism of disuse muscle atrophy. Therefore, the aim of this study was to determine if long-term radical scavenger treatment with edaravone following an acute stroke prevents the progression of disuse muscle atrophy and improves leg locomotor function in the chronic phase.
Methods: This randomized controlled pilot study was conducted at 19 acute stroke and rehabilitation centers across Japan. Forty-seven ischemic stroke patients with at least leg motor weakness admitted within 24 hours of onset were randomly assigned to receive continuous intravenous infusions of edaravone 30 mg twice daily for 3 days (short-term group) or 10–14 days (long-term group). The primary endpoints of the study included the degree of leg disuse muscle atrophy, as measured by the percentage change from baseline in femoral muscle circumference 15 cm above the knee, and the improvement in leg locomotor function, as assessed by the maximum walking speed over 10 m, 3 months after the onset of stroke.
Results: Three-month follow-up was completed by a total of 41 patients (21 in the short-term group and 20 in the long-term group). On admission, there was no significant difference in the severity of stroke or the grade of leg paresis between the two treatment groups. The grade of disuse muscle atrophy and incidence of gait impairment 3 weeks after stroke onset were also similar between the short- and long-term groups. However, disuse muscle atrophy of the paretic and non-paretic legs was significantly less severe in the long-term versus the short-term treatment group (3.6±5.9% and 1.5±6.0% vs 8.3±5.2% and 5.7±6.4%; p<0.01 and p<0.05) 3 months after stroke onset. Additionally, the maximum walking speed over a distance of 10 m was significantly greater in the long-term group (98±67 vs 54±55 cm/sec; p<0.05).
Conclusion: Edaravone treatment for up to 14 days suppresses the progression of disuse muscle atrophy and improves leg locomotor function to a greater extent than shorter-term treatment in acute stroke patients. This suggests that the management of stroke may be improved with long-term edaravone therapy by providing myoprotective effects that ameliorate functional outcome in the chronic phase.
影响因子：
3.2
作者：
Lapchak PA
通讯作者：
Lapchak PA