#1
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Íåéðîïðîòåêòîðû ïðè èíñóëüòå. Äîñüå.
Ê êîíöó 1999 ãîäà îïóáëèêîâàíû (íà àíãëèéñêîì ÿçûêå) ðåçóëüòàòû 178 êîíòðîëèðóåìûõ êëèíè÷åñêèõ èññëåäîâàíèé ïî ëå÷åíèþ îñòðîãî èøåìè÷åñêîãî èíñóëüòà. 88 ïî íåéðîïðîòåêòèâíûì ïðåïàðàòàì, 59 ïî ðåîëîãè÷åñêèì/àíòèòðîìáîòè÷åñêèì ïðåïàðàòàì, 26 ïî ïðåïàðàòàì ñ êîìáèíèðîâàííûì äåéñòâèåì (íåéðîïðîòåêòèâíûì è ðåîëîãè÷åñêèì/àíòèòðîìáîòè÷åñêèì) è 5 ïî íåôàðìàêîëîãè÷åñêèì ìåòîäàì. Òåñòèðîâàíî 37 íåéðîïðîòåêòèâíûõ ïðåïàðàòîâ è 12 ïðåïàðàòîâ ñ êîìáèíèðîâàííûì äåéñòâèåì (íåéðîïðîòåêòèâíûì è ðåîëîãè÷åñêèì/àíòèòðîìáîòè÷åñêèì).
Kidwell CS, Liebeskind DS, Starkman S, Saver JL. Trends in acute ischemic stroke trials through the 20th century. Stroke. 2001;32(6):1349-59 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#2
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Ïàòîãåíåç èøåìè÷åñêîãî ïîâðåæäåíèÿ ìîçãà
- èøåìèÿ
- äåïîëÿðèçàöèÿ ïðåñèíàïòè÷åñêîãî íåéðîíà - àêòèâàöèÿ Na+ K+ – ïîìïû - âûñâîáîæäåíèå ýêñàéòîòîêñè÷íûõ àìèíîêèñëîò: ãëóòàìàòà, àñïàðòàòà, -- ãëèöèíà, òàóðèíà - àêòèâàöèÿ NMDA-ðåöåïòîðîâ, AMPA-ðåöåïòîðîâ - íàêîïëåíèå Ca2+ â êëåòêå - àêòèâàöèÿ âíóòðèêëåòî÷íûõ ôåðìåíòîâ - ïîâûøåíèå ñèíòåçà NO è ðàçâèòèå îêñèäàíòíîãî ñòðåññà - ïîâðåæäåíèå êëåòêè ôåðìåíòàìè è ïðîäóêòàìè ìåòàáîëèçìà (ñâîáîäíûå ðàäèêàëû) - ðåàêöèè ìåñòíîãî âîñïàëåíèÿ, ìèêðîâàñêóëÿðíûå íàðóøåíèÿ, ïîâðåæäåíèå ÃÝÁ Danton GH, Dalton Dietrich W. The Search for Neuroprotective Strategies in Stroke. AJNR Am J Neuroradiol 2004 25:181–194. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#3
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Ôàçû êëèíè÷åñêèõ èññëåäîâàíèé
I ôàçà: èññëåäîâàíèå íîâîãî ïðåïàðàòà èëè ìåòîäà ëå÷åíèÿ íà íåáîëüøîé ãðóïïå ëþäåé (20 – 80) äëÿ îöåíêè áåçîïàñíîñòè, îïðåäåëåíèÿ áåçîïàñíîé äîçû è èäåíòèôèêàöèè ïîáî÷íûõ ýôôåêòîâ
II ôàçà: èññëåäîâàíèå ïðåïàðàòà èëè ìåòîäà ëå÷åíèÿ íà áîëüøåé ãðóïïå ëþäåé (200 – 300) äëÿ ïðåäâàðèòåëüíîé îöåíêè ýôôåêòèâíîñòè è äàëüíåéøåé îöåíêè áåçîïàñíîñòè III ôàçà: èññëåäîâàíèå ïðåïàðàòà èëè ìåòîäà ëå÷åíèÿ íà áîëüøîé ãðóïïå ëþäåé (1000 – 3000 è áîëåå) äëÿ ïîäòâåðæäåíèÿ åãî ýôôåêòèâíîñòè, ìîíèòîðèíãà ïîáî÷íûõ ýôôåêòîâ, ñðàâíåíèÿ ñ òðàäèöèîííûìè ïðåïàðàòàìè è ïðèíÿòèÿ ðåøåíèÿ î âîçìîæíîñòè èñïîëüçîâàíèÿ ýòîãî ïðåïàðàòà (ìåòîäà ëå÷åíèÿ) â òåðàïèè IV ôàçà: ïîñòìàðêåòèíãîâîå èññëåäîâàíèå äëÿ ïîëó÷åíèÿ äîïîëíèòåëüíîé èíôîðìàöèè (ðèñê, ïîëüçà, îïòèìàëüíûå ðåæèìû) U.S. National Institutes of Health [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#4
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Àíòàãîíèñòû NMDA – ðåöåïòîðîâ
ñåëôîòåëü – íåò ýôôåêòà.
2 ÐÊÈ III ôàçû (ASSIST trials) îñòàíîâëåíû èç-çà îòñóòñòâèÿ ýôôåêòà (Barthel index > 60 ÷åðåç 3 ìåñ), óâåëè÷åíèÿ ñìåðòíîñòè ÷åðåç 8 è 30 äíåé (îñîáåííî â ïîäãðóïïå òÿæåëîãî èíñóëüòà).  ãðóïïå ñåëôîòåëÿ îòìå÷àëîñü áîëüøåå êîëè÷åñòâî ïñèõîòîìèìåòè÷åñêèõ ýôôåêòîâ. Davis SM, Lees KR, Albers GW, Diener HC, Markabi S, Karlsson G, Norris J. Selfotel in acute ischemic stroke : possible neurotoxic effects of an NMDA antagonist. Stroke. 2000 Feb;31(2):347-54. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] àïòèãàíåëü (öåðåñòàò) - íåò ýôôåêòà. Èññëåäîâàíèå III ôàçû (Aptiganel Acute Stroke Trial) ïðåêðàùåíî äîñðî÷íî. Ðàíäîìèçèðîâàíî 628 èç çàïëàíèðîâàííûõ 900 áîëüíûõ. ×åðåç 90 äíåé íåò ðàçëè÷èé â ôóíêöèîíàëüíîì èñõîäå (Modified Rankin Scale). Ñìåðòíîñòü â ãðóïïå àïòèãàíåëÿ â âûñîêîé äîçå ÷åðåç 120 äíåé áûëà âûøå (26.3% vs 19.2% ïëàöåáî; P = .06). Albers GW, Goldstein LB, Hall D, Lesko LM. Aptiganel hydrochloride in acute ischemic stroke: a randomized controlled trial. JAMA 2001; 286: 2673–2682. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ýëèïðîäèë – áëîêàòîð ïîëèàìèíîâîãî ñàéòà NMDA – ðåöåïòîðà íåò ýôôåêòà. Èññëåäîâàíèå III ôàçû ïðåêðàùåíî. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#5
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Àíòàãîíèñòû NMDA – ðåöåïòîðîâ
Àíòàãîíèñò ãëèöèîíîâîãî ñàéòà NMDA-ðåöåïòîðîâ
ãàâåñòåíèë – íåò ýôôåêòà 2 ÐÊÈ III ôàçû1, 2: 1-å ÐÊÈ (GAIN International, n=1804), 2-å ÐÊÈ (GAIN Americas, n=1367) ×åðåç 3 ìåñÿöà ôóíêöèîíàëüíûé èñõîä (Barthel index) íå óëó÷øàëñÿ, ñìåðòíîñòü íå ñíèæàëàñü 1. Lees KR, Asplund K, Carolei A et al. Glycine antagonist (gavestinel) in neuroprotection (GAIN International) in patients with acute stroke: a randomised controlled trial. GAIN International Investigators. Lancet. 2000; 355(9219):1949-54 2. Sacco RL, DeRosa JT, Haley EC Jr et al; Glycine Antagonist in Neuroprotection Americas Investigators. Glycine antagonist in neuroprotection for patients with acute stroke: GAIN Americas: a randomized controlled trial. JAMA. 2001; 285(13):1719-28 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Èíãèáèòîð âûñâîáîæäåíèÿ ãëóòàìàòà ëàáåëóçîë - ìåòà-àíàëèç: 5 ÐÊÈ, 3510 ïàöèåíòîâ. Íåò ýôôåêòà îòíîñèòåëüíî ñìåðòíîñòè + èíâàëèäíîñòè (ÎØ 1.03, 95% ÄÈ 0.91-1.19) Gandolfo C, Sandercock P, Conti M. Lubeluzole for acute ischaemic stroke. Cochrane Database Syst Rev CD001924, 2002 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#6
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GABA (ÃÀÌÊ) -àãîíèñòû
êëîìåòèàçîë – íåò ýôôåêòà, 2 ÐÊÈ III ôàçû (CLASS n=1360 è CLASS-1 n=1198) [1, 2]
1. Wahlgren NG, Ranasinha KW, Rosolacci T et al. Clomethiazole acute stroke study (CLASS): results of a randomized, controlled trial of clomethiazole versus placebo in 1360 acute stroke patients. Stroke. 1999; 30(1):21-8 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2. Lyden P, Shuaib A, Ng K, Clomethiazole Acute Stroke Study in ischemic stroke (CLASS-I): final results. Stroke. 2002; 33(1):122-8[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] äèàçåïàì – íåò ýôôåêòà. ÐÊÈ EGASIS, n=843. Ïåðâè÷íûé èñõîä (Rankin Scale < 3) ÎØ 1.14, 95% ÄÈ 0.87 - 1.49 Lodder J, van Raak L, Hilton A, Hardy E, Kessels A; EGASIS Study Group. Diazepam to improve acute stroke outcome: results of the early GABA-Ergic activation study in stroke trial. a randomized double-blind placebo-controlled trial. Cerebrovasc Dis. 2006;21(1-2):120-7 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#7
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Ñóëüôàò Ìàãíèÿ (MgSO4)
Ìåõàíèçì äåéñòâèÿ:
- èíãèáèðîâàíèå âûáðîñà ãëóòàìàòà - àíòàãîíèñò NMDA-ðåöåïòîðîâ - àíòàãîíèñò êàëüöèÿ - àíòàãîíèñò âàçîêîíñòðèêòîðîâ (ýíäîòåëèí – 1) [1] íåò ýôôåêòà â ïåðâûå 12 ÷àñîâ: ÐÊÈ IMAGES 2589 ïàöèåíòîâ áûëè ðàíäîìèçèðîâàíû â ïåðâûå 12 ÷ îò íà÷àëà èíñóëüòà. 16 ììîëü MgSO4 â/â 15 ìèíóò è çàòåì 65 ììîëü çà 24 ÷ èëè ïëàöåáî (1 ììîëü MgSO4 = 1 ìë 25% ðàñòâîðà). Ñìåðòíîñòü + òÿæåëàÿ èíâàëèäíîñòü íå îòëè÷àëèñü ìåæäó ãðóïïàìè (ÎØ 0.95, 95% ÄÈ 0.80 – 1.13, p=0.59) Ñìåðòíîñòü áûëà íåñêîëüêî âûøå â ãðóïïå MgSO4 (ÎÐ 1.18, 95% ÄÈ 0.97-1.42, p=0.098) Íåëüçÿ èñêëþ÷èòü íåêîòîðóþ ïîëüçó ïðè ëàêóíàðíîì èíñóëüòå [2] - Èññëåäîâàíèå FAST-MAG (ïðîäîëæàåòñÿ) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (Field Administration of Stroke Therapy - Magnesium Phase III Trial) çàïëàíèðîâàíî ðàíäîìèçèðîâàòü 1298 ïàöèåíòîâ íà÷àëî ëå÷åíèÿ ïàðàìåäèêàìè â ïåðâûå 2 ÷àñà îò íà÷àëà èíñóëüòà 4 ã â/â áîëþñ è äàëåå èíôóçèÿ 16 ã çà 24 ÷àñà 1. K W Muir. Magnesium in stroke treatment. Postgrad Med J 2002;78:641–645 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2. Muir KW, Lees KR, Ford I, Davis S; Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators. Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke trial): randomised controlled trial. Lancet. 2004; 363(9407):439-45 |
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#8
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Ìîäóëÿòîðû èîííûõ êàíàëîâ
Áëîêàòîðû Na-êàíàëîâ
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] – íåýôôåêòèâåí. Èññëåäîâàíèå III ôàçû (Fosphenytoin Phase 3) îñòàíîâëåíî, ðåçóëüòàòû íå îïóáëèêîâàíû. Ðàíäîìèçèðîâàíî 233 ïàöèåíòà â ãðóïïó ôîñôåíèòîèíà è 229 â ãðóïïó ïëàöåáî. Íå ðàçëè÷èé ïî ïåðâè÷íûì (Modified Rankin Scale ÷åðåç 3 ìåñÿöà) è âòîðè÷íûì êîíå÷íûì òî÷êàì. Àêòèâàòîðû Ê+ êàíàëîâ [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (MaxiPost) – íåýôôåêòèâåí (èññëåäîâàíèå III ôàçû îñòàíîâëåíî â ñâÿçè ñ íåãàòèâíûìè ðåçóëüòàòàìè) |
#9
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Ñêåâåíäæåðû ñâîáîäíûõ ðàäèêàëîâ
òèðèëàçàä – ìîæåò óõóäøàòü ïåðâè÷íûé èñõîä.
Ñìåðòíîñòü + èíâàëèäíîñòü íà 20% âûøå â ãðóïïå òèðèëàçàäà. (ìåòà-àíàëèç 6 ÐÊÈ n=1757 ïàöèåíòîâ) Bath PM, Iddenden R, Bath FJ, Orgogozo JM; Tirilazad International Steering Committee. Tirilazad for acute ischaemic stroke. Cochrane Database Syst Rev. 2001;(4):CD002087 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] NXY-059 ÐÊÈ (SAINT I study) n=1722 (â àíàëèç âêëþ÷åíî 1699 ïàöèåíòîâ) ×åðåç 90 äíåé óëó÷øåíèå îñíîâíîãî èñõîäà ïî modified Rankin scale íà 1.20 (95% ÄÈ 1.01 - 1.42) Íåò ýôôåêòà ïî øêàëå NIHSS è Barthel index Íà÷àòî íîâîå èññëåäîâàíèå SAINT II Lees KR, Zivin JA, Ashwood T, Davalos A, Davis SM, Diener HC, Grotta J, Lyden P, Shuaib A, Hardemark HG, Wasiewski WW; Stroke-Acute Ischemic NXY Treatment (SAINT I) Trial Investigators. NXY-059 for acute ischemic stroke. N Engl J Med. 2006 Feb 9;354(6):588-600[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ][Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#10
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Àíòàãîíèñò îïèàòíûõ êàïïà-ðåöåïòîðîâ
íàëìåôåí – íåò ýôôåêòà.
ÐÊÈ n=368. Íåò ñòàòèñòè÷åñêè çíà÷èìûõ ðàçëè÷èé ìåæäó ãðóïïàìè íàëìåôåíà è ïëàöåáî ïî ïåðâè÷íîìó èñõîäó (Barthel Index > 60). Clark WM, Raps EC, Tong DC, Kelly RE. Cervene (Nalmefene) in acute ischemic stroke : final results of a phase III efficacy study. The Cervene Stroke Study Investigators. Stroke. 2000 Jun;31(6):1234-9. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#11
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Áëîêàòîð àäãåçèâíûõ ìîëåêóë
ýíëèìîìàá – ìîíîêëîíàëüíîå àíòè-ICAM-1 àíòèòåëî
Íå ýôôåêòèâåí. Ìîæåò çíà÷èòåëüíî óõóäøàòü èñõîä ïðè îñòðîì èíñóëüòå. ÐÊÈ III ôàçû EAST (Enlimomab Acute Stroke Trial) n=625. Ïåðâè÷íûé èñõîä (Modified Rankin scale ÷åðåç 90 äíåé) áûë õóæå â ãðóïïå ýíëèìîìàáà, ÷åì â ãðóïïå ïëàöåáî. Ñìåðòíîñòü 22.2% â ãðóïïå ýíëèìîìàáà vs 16.2% â ãðóïïå ïëàöåáî. Enlimomab Acute Stroke Trial Investigators. Use of anti-ICAM-1 therapy in ischemic stroke: results of the Enlimomab Acute Stroke Trial. Neurology. 2001;57(8):1428-34 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#12
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Ìîíîñèàëîãàíãëèîçèä GM-1
Óìåíüøàåò ÷óâñòâèòåëüíîñòü ê èøåìèè â ýêñïåðèìåíòàëüíûõ ìîäåëÿõ
Ìåõàíèçì äåéñòâèÿ íåèçâåñòåí Ìåòà-àíàëèç 12 ÐÊÈ n=2265: Íåò ýôôåêòà: ñìåðòíîñòü (ÎØ 0.91, 95% ÄÈ 0.73 - 1.13), èíâàëèäíîñòü: ðàçíèöà ïî Barthel Index 2.1; 95% ÄÈ - 4.8 - 8.9 1 ñëó÷àé ñèíäðîìà Guillain-Barré Áóäóùèå èññëåäîâàíèÿ íå ïëàíèðóþòñÿ Candelise L, Ciccone A. Gangliosides for acute ischemic stroke. Stroke. 2002; 33(9):2336[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#13
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Ñòàáèëèçàòîð êëåòî÷íûõ ìåìáðàí íåéðîíîâ
Öèòèõîëèí
ïðîìåæóòî÷íûé ïðîäóêò ñèíòåçà ôîñôàòèäèëõîëèíà ìåòà-àíàëèç 4 ÐÊÈ (n=1372): íà÷àëî ïðèåìà â ïåðâûå 24 ÷ è äàëåå â òå÷åíèå 6 íåäåëü óâåëè÷èâàåò âåðîÿòíîñòü ïîëíîãî âîññòàíîâëåíèÿ â òå÷åíèå 3 ìåñÿöåâ (25.2% â ãðóïïå öèòèõîëèíà è 20.2% â ãðóïïå ïëàöåáî (ÎØ 1.33; 95% ÄÈ 1.10 - 1.62; P=0.0034) ïðè ñðåäíå-òÿæåëîì è òÿæåëîì èíñóëüòå (NIHSS score ≥ 8) Íàèáîëüøèé ýôôåêò äîçû 2000 ìã/ñóò [1] Ïî ðåçóëüòàòàì ýòîãî ìåòà-àíàëèçà â ÿíâàðå 2006 íà÷àòî ÐÊÈ ICTUS (International Citicoline Trial on Acute Stroke). Ïëàíèðóåòñÿ ðàíäîìèçèðîâàòü 2600 ïàöèåíòîâ ñ NIHSS score ≥ 8 â ïåðâûå 24 ÷ 1000 ìã õ 2 ð/ñóò â/â 3 äíÿ è äàëåå 2000 ìã âíóòðü 6 íåä. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 1. Davalos A, Castillo J, Alvarez-Sabin J at al. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke. 2002; 33(12):2850-7[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ãëèàòèëèí (õîëèí àëüôîñöåðàò, L-alpha glycerylphosphorylcholine) õîëèí + ãëèöåðîôîñôàò: õîëèí ó÷àñòâóåò â áèîñèíòåçå àöåòèëõîëèíà; ãëèöåðîôîñôàò ÿâëÿåòñÿ ïðåäøåñòâåííèêîì ôîñôàòèäèëõîëèíà (ëåöèòèíà) íåéðîííîé ìåìáðàíû ÐÊÈ ïî èíñóëüòó íå áûëî ÐÊÈ ïî ×ÌÒ íå áûëî 1 ÐÊÈ ïðè áîëåçíè Àëüöãåéìåðà: 1200 ìã õ 180 äíåé. n=261 (132 ãëèàòèëèí vs. 129 ïëàöåáî). Óëó÷øåíèå êîãíèòèâíîé ôóíêöèè â ãðóïïå ãëèàòèëèíà [1]. 1. De Jesus Moreno Moreno M. Cognitive improvement in mild to moderate Alzheimer's dementia after treatment with the acetylcholine precursor choline alfoscerate: a multicenter, double-blind, randomized, placebo-controlled trial. Clin Ther. 2003;25(1):178-93 |
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Ïèðàöåòàì
Ïðè èíñóëüòå: íàèáîëåå êðóïíîå ÐÊÈ PASS (n=927) â ïåðâûå 12 ÷àñîâ 12 ã õ 4 íåäåëè, 4.8 ã õ 8 íåäåëü
Íåò ýôôåêòà. Post hoc àíàëèç ïîêàçàë, ÷òî ïèðàöåòàì ìîæåò áûòü ýôôåêòèâåí â ïåðâûå 7 ÷àñîâ èíñóëüòà [1] - êðîìå òîãî, ìîæåò áûòü ýôôåêòèâåí äëÿ ëå÷åíèÿ àôàçèè ïîñëå èíñóëüòà. [2] Äëÿ ïîäòâåðæäåíèÿ ýòîé ãèïîòåçû íà÷àòî èññëåäîâàíèå PASS II (ïèðàöåòàì â ïåðâûå 7 ÷àñîâ ïðè àôàçè÷åñêîì èíñóëüòå). Ðåçóëüòàòû îæèäàëèñü â 2001 ã. P.S. Ïðè äåìåíöèè ñóùåñòâóþùèå äîêàçàòåëüñòâà íå ïîääåðæèâàþò èñïîëüçîâàíèå ïèðàöåòàìà [3] 1. De Deyn PP, Reuck JD, Deberdt W, Vlietinck R, Orgogozo JM. Treatment of acute ischemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group. Stroke. 1997 Dec;28(12):2347-52 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2. Greener J, Enderby P, Whurr R. Pharmacological treatment for aphasia following stroke. Cochrane Database Syst Rev 2001; (4):CD000424[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 3. Flicker L, Grimley Evans G. Piracetam for dementia or cognitive impairment. Cochrane Database Syst Rev. 2001;(2):CD001011[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Öåðåáðîëèçèí
- êîìïëåêñ íèçêîìîëåêóëÿðíûõ ïåïòèäîâ, ïîëó÷åííûõ èç ãîëîâíîãî ìîçãà ñâèíüè
- ìåõàíèçì äåéñòâèÿ íåèçâåñòåí 1-å ÐÊÈ: 146 ïàöèåíòîâ (78 öåðåáðîëèçèí vs. 68 ïëàöåáî)1 ïî 50 ìë â/â â äåíü â òå÷åíèå 21 äíÿ Íåò ýôôåêòà ïî CNS score, Barthel Index è Clinical Global Impressions. Îòìå÷àëîñü óëó÷øåíèå ïî Syndrome Short Test [1] 2-å ÐÊÈ (Âåíãðèÿ) n=48 20 ìë õ 20 äíåé vs. ïëàöåáî Íåò ýôôåêòà ïî Barthel Index (BI), Graded Neurological Scale (GNS) Ïîëîæèòåëüíûé ýôôåêò â ãðóïïå öåðåáðîëèçèíà ïî Physiology Hemiplegia Assessment (PHA)[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 3-å ÐÊÈ (îòå÷åñòâåííîå) n=36. 12 ïàöèåíòîâ â 3 ãðóïïàõ: 10 ìë/ñóò, 50 ìë/ñóò vs. ïëàöåáî Ñòàòèñòè÷åñêè íåçíà÷èìûé òðåíä ê ëó÷øåìó èñõîäó â ãðóïïàõ öåðåáðîëèçèíà [3] 1. Ladurner G, Kalvach P, Moessler H. Neuroprotective treatment with Cerebrolysin in patients with acute stroke: a randomised controlled trial. J Neural Transm. 2005; 112(3):415-28 3. Ñêâîðöîâà Â.È., Ñòàõîâñêàÿ Ë.Â., Ãóáñêèé Ë.Â. è äð. Ðàíäîìèçèðîâàííîå äâîéíîå ñëåïîå ïëàöåáîêîíòðîëèðóåìîå èññëåäîâàíèå áåçîïàñíîñòè è ýôôåêòèâíîñòè öåðåáðîëèçèíà äëÿ ëå÷åíèÿ îñòðîãî èøåìè÷åñêîãî èíñóëüòà Èíñóëüò. Ïðèëîæåíèå ê æóðíàëó íåâðîëîãèè è ïñèõèàòðèè èì. Ñ.Ñ.Êîðñàêîâà Âûïóñê 11, 2004 ã (Skvortsova VI, Stakhovskaia LV, Gubskii LV, Shamalov NA, Tikhonova IV, Smychkov AS. [A randomized, double-blind, placebo-controlled study of Cerebrolysin safety and efficacy in the treatment of acute ischemic stroke] Zh Nevrol Psikhiatr Im S S Korsakova. 2004;(Suppl 11):51-5.) |