Zhou Hongxing, Huang Suyun, Sunnassee Gavin, Guo Weiyu, Chen Jian, Guo Yang, Tan Sheng
a Department of Neurology , Zhujiang Hospital of Southern Medical University , Guangzhou , China.
b Department of Ultrasound , Zhujiang Hospital of Southern Medical University , Guangzhou , China.
Int J Neurosci. 2017 Nov;127(11):1036-1046. doi: 10.1080/00207454.2017.1286338. Epub 2017 Feb 7.
The narrow therapeutic time window and risk of intracranial hemorrhage largely restrict the clinical application of thrombolysis in acute ischemic stroke. Adjunctive treatments added to rt-PA may be beneficial to improve the capacity of neural cell to withstand ischemia, and to reduce the hemorrhage risk as well. This review aims to evaluate the neuroprotective effects of adjunctive treatments in combination with thrombolytic therapy for acute ischemic stroke. Relevant studies were searched in the PubMed, Web of Science and EMBASE database. In this review, we first interpret the potential role of adjunctive treatments to thrombolytic therapy in acute ischemic stroke. Furthermore, we summarize the current clinical evidence for the combination of intravenous recombinant tissue plasminogen activator and various adjunctive therapies in acute ischemic stroke, either pharmacological or non-pharmacological therapy, and discuss the mechanisms of some promising treatments, including uric acid, fingolimod, minocycline, remote ischemic conditioning, hypothermia and transcranial laser therapy. Even though fingolimod, minocycline, hypothermia and remote ischemic conditioning have yielded promising results, they still need to be rigorously investigated in further clinical trials. Further trials should also focus on neuroprotective approach with pleiotropic effects or combined agents with multiple protective mechanisms.
急性缺血性卒中溶栓治疗的临床应用受到狭窄治疗时间窗和颅内出血风险的极大限制。在重组组织型纤溶酶原激活剂（rt-PA）基础上增加辅助治疗可能有助于提高神经细胞耐受缺血的能力，并降低出血风险。本综述旨在评估辅助治疗联合溶栓疗法对急性缺血性卒中的神经保护作用。在PubMed、科学网和EMBASE数据库中检索相关研究。在本综述中，我们首先阐释辅助治疗在急性缺血性卒中溶栓治疗中的潜在作用。此外，我们总结了目前关于静脉注射重组组织型纤溶酶原激活剂与各种辅助疗法（包括药物治疗或非药物治疗）联合用于急性缺血性卒中的临床证据，并讨论了一些有前景的治疗方法的机制，包括尿酸、芬戈莫德、米诺环素、远隔缺血预处理、低温和经颅激光治疗。尽管芬戈莫德、米诺环素、低温和远隔缺血预处理已取得了有前景的结果，但仍需在进一步的临床试验中进行严格研究。进一步的试验还应侧重于具有多效性的神经保护方法或具有多种保护机制的联合药物。
