Magkou Dimitra, Tziomalos Konstantinos
Dimitra Magkou, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece.
World J Diabetes. 2014 Apr 15;5(2):84-8. doi: 10.4239/wjd.v5.i2.84.
Ischemic stroke is a leading cause of mortality and long-term disability worldwide. Given the detrimental effects of acute stroke, several neuroprotective agents have been evaluated in these patients. However, the benefits of the evaluated agents appear to be limited and none is currently recommended for clinical use. On the other hand, prior treatment with agents that are used for the primary and secondary prevention of stroke, including statins and antiplatelets, has been associated with better outcome in patients who experience an acute stroke. In contrast, there are limited data as to whether prior treatment with antidiabetic agents is beneficial in diabetic patients who suffer a stroke. In this context, the findings of a recent study that showed reduced stroke size following pretreatment with linagliptin, a dipeptidyl peptidase-4 (DDP-4) inhibitor, compared with glimepiride, in both diabetic and non-diabetic mice, appear promising. Despite these preclinical findings suggesting neuroprotective effects of DPP-4 inhibitors in acute stroke, it is still unclear whether these actions will also be observed in humans. Of note, two recent large randomized, placebo-controlled studies did not show any effect of DPP-4 inhibitors on cardiovascular events, including stroke. Several other ongoing trials are evaluating the effects of DPP-4 inhibitors on cardiovascular morbidity and mortality. These studies also provide a major opportunity to assess whether patients treated with this class of antidiabetic agents will suffer from less severe strokes and whether their outcome after stroke will be more favorable.
缺血性中风是全球范围内导致死亡和长期残疾的主要原因。鉴于急性中风的有害影响，已在这些患者中评估了几种神经保护剂。然而，所评估药物的益处似乎有限，目前尚无一种药物被推荐用于临床。另一方面，使用包括他汀类药物和抗血小板药物在内的用于中风一级和二级预防的药物进行预先治疗，与急性中风患者的更好预后相关。相比之下，关于预先使用抗糖尿病药物对中风糖尿病患者是否有益的数据有限。在这种背景下，最近一项研究的结果显示，在糖尿病和非糖尿病小鼠中，与格列美脲相比，用二肽基肽酶-4（DPP-4）抑制剂利格列汀进行预处理后中风面积减小，这一结果似乎很有前景。尽管这些临床前研究结果表明DPP-4抑制剂在急性中风中具有神经保护作用，但仍不清楚这些作用在人类中是否也会出现。值得注意的是，最近两项大型随机、安慰剂对照研究未显示DPP-4抑制剂对包括中风在内的心血管事件有任何影响。其他几项正在进行的试验正在评估DPP-4抑制剂对心血管发病率和死亡率的影响。这些研究也提供了一个重要机会，以评估接受这类抗糖尿病药物治疗的患者是否会发生不太严重的中风，以及他们中风后的预后是否会更有利。
