Neuroprotection in acute stroke: targeting excitotoxicity, oxidative and nitrosative stress, and infl ammation
Neuroprotection in acute stroke: targeting excitotoxicity, oxidative and nitrosative stress, and infl ammation
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DOI：
10.1016/s1474-4422(16)00114-9
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发表时间：
2016-07-01
期刊：
影响因子：
48
通讯作者：
Planas, Anna M.
中科院分区：
文献类型：
--
作者：
Chamorro, Angel;Dirnagl, Ulrich;Planas, Anna M.
在证实血管内取栓术优于全身溶栓后，急性缺血性中风的治疗方法仍在不断发展。不幸的是，许多神经保护药物在治疗急性缺血性中风方面并未显示出疗效，因此寻找新的治疗方法势在必行。提高对严格的临床前试验相关性的认识，并适当选择研究参与者，可能会克服中风研究进展的障碍。相关领域包括寻找安全有效的治疗策略，结合神经保护和再灌注，更好地利用先进的脑成像技术选择患者，以及更广泛地实施院前进行的临床试验。在过去5年内完成的联合治疗的随机对照试验包括生长因子、低温、米诺环素、那他珠单抗、Fingolimod和尿酸；后两种使用阿尔替普酶的药物产生了令人鼓舞的结果。在临床试验中，也在用新的方法重新评估兴奋毒性的阻断，例如突触后密度-95抑制剂NA-1，或腹膜透析以清除多余的谷氨酸。这些随机试验的结果有望改善急性中风患者的治疗选择和临床结果。
Treatments for acute ischaemic stroke continue to evolve after the superior value of endovascular thrombectomy was confirmed over systemic thrombolysis. Unfortunately, numerous neuroprotective drugs have failed to show benefit in the treatment of acute ischaemic stroke, making the search for new treatments imperative. Increased awareness of the relevance of rigorous preclinical testing, and appropriate selection of study participants, might overcome the barriers to progress in stroke research. Relevant areas of interest include the search for safe and effective treatment strategies that combine neuroprotection reperfusion, better use of advanced brain imaging for patient selection, and wider implementation of prehospital conducted clinical trials. Randomised controlled trials of combination treatments completed within the past 5 years have included growth factors, hypothermia, minocycline, natalizumab, fingolimod, and uric acid; the latter two drugs with alteplase produced encouraging results. Blocking of excitotoxicity is also being reassessed in clinical trials with new approaches, such as the postsynaptic density-95 inhibitor NA-1, or peritoneal dialysis to remove excess glutamate. The findings of these randomised trials are anticipated to improve treatment options and clinical outcomes in of patients with acute stroke.