缺血性卒中药物临床前研究的挑战及其对策

Advances and challenges in preclinical evaluation of therapeutic drugs for treating ischemic stroke

目前缺血性卒中临床前研究所面临的最大挑战是临床转化困难,造成转化困难的原因主要有:动物模型无法复制人类所发生的缺血性卒中;实验设计没有遵循盲法、随机原则;没有预先设定纳入/排除标准;样本量设置不合理;终点指标的选择和评价方法不科学;实验数据的统计缺陷、发表偏倚或不完全等。为此世界各卒中研究学会为临床前研究的实验设计和数据报道制订了相关的准则与指南,包括:改进动物模型和动物实验设计;使用新技术方法对终点指标进行检测;发表阴性结果;建立临床前研究的事先注册与过程监督机制;开展多中心的随机对照临床前实验;采用meta-分析的方法对临床前研究结果进行分析和评价;除以神经保护为靶点外,关注神经血管单元和卒中病理生理级联反应。

Translating of scientific advances into clinical practice is a major challenge in the stroke research field in the past decades. There were many reasons involved： animal models might not accurately capture all aspects of clinical stroke in humans, the blind and randomized design principle was not closely followed, the inclusion and exclusion criteria was not previously established, sample size was inadequate, endpoint was not scientific nor blindly assessed, inadequate reporting of data and statistical flaws. To bridge the gap between experimental and clinical research, international consortia have attempted to establish standardized guidelines for study design and data report, which include optimizing animal models as well as experimental design, using innovative approaches to assess endpoint, making raw data and negative results available, establishing prior registration mechanism, conducting multicenter preclinical randomized controlled trials（p RCTs）, systematic reviews and meta-analysis of preclinical studies, evolving the original focus on neuroprotection into a broader consideration of the role of neurovascular unit and ischemic cascade.