脑血管病神经保护治疗的现状、趋势及存在问题

Current status of neuroprotection in cerebrovascular disease

对近年最新的有关脑血管病神经保护治疗的研究进行综述。目前神经保护治疗的主要类型 ,包括离子通道调节药、抗兴奋毒性作用、自由基清除剂、神经营养因子、低温处理以及基因治疗和神经干细胞治疗等。不同治疗的目的大多是通过阻止缺血分子瀑的一个或多个环节的发展来减轻脑缺血损伤。多数神经保护药的临床疗效尚未被证实 ,有些制剂因其不良反应大而被弃用。由于神经保护治疗有着很广的适应证 ,因而引起人们的广泛重视。目前至少有 6个神经保护药正在进行Ⅲ期临床试验 。

The role of neuroprotection in the treatment of acute cerebrovascular disease is reviewed. Various neuroprotective strategies include ion channel modulators,anti excitotoxic agents,free radical scavengers,neurrotrophic factors,hypothermia,gene therapy and stem cells. The various agents aim to prevent the progression of ischemic cascade therefore reducing brain injury through more than one point in the ischemic cascade. Clinical effectiveness of most of the strategies has not been proven in clinical trials. Some of which had to be abandoned due to adverse effects outweighing the beneficial effects. At least six neuroprotective agents based on various mechanisms are in phase Ⅲ of clinical trials. The most promising appear to be free radical scavengers and anti excitotoxic agents.