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依达拉奉治疗急性脑卒中患者的安全性和有效性:一项随机临床试验方案。

Safety and efficacy of edaravone for patients with acute stroke: A protocol for randomized clinical trial.

机构信息

Department of Neurology, Affiliated Hospital of Chengde Medical University, Hebei, China.

出版信息

Medicine (Baltimore). 2021 Feb 26;100(8):e24811. doi: 10.1097/MD.0000000000024811.

Abstract

BACKGROUND

We performed a randomized clinical trial protocol to assess the effectiveness of edaravone for acute stroke. We hypothesized that edaravone is beneficial in improving neurological impairment resulting from acute stroke.

METHOD

The protocol was reviewed and approved by the Research Ethics Board of Affiliated Hospital of Chengde Medical University (0092-2394), each participant signed a written consent before participating, and SPIRIT guidelines were followed throughout. The inclusion criteria for patients were as follows: diagnosed as acute stroke (ischemic stroke or intracerebral hemorrhage) by head CT or MRI within 72 hours; age greater than 18; motor function disorder; Glasgow Coma Scale greater than 12. Patients with the following symptoms were excluded: concurrent serious complications, such as coma, drug allergy, mental disorder, and other severe organic lesions in the brain. Sixty patients were finally included in the study. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these 2 groups were tested and compared.

DISCUSSION

As aging worsens, the incidence of acute stroke continues to increase. Brain damage will induce the production of oxygen radicals, which can damage the cytomembrane of brain cells and finally damage the nervous system and cause cerebral injury as well as the cerebral edema. Edaravone is an antioxidant and oxygen radical scavenger that can inhibit lipid peroxidation during the scavenging of oxygen free radicals. Besides, it can also elicit anti-inflammatory protective effects for nerve cells, increase cerebral blood flow volume, prevent the aggravation of cerebral hypoperfusion toward necrosis, reduce nerve damage, and improve neurological functions and prognosis. This is the first randomized controlled trial to assess the efficacy of edaravone for treating acute stroke. High quality, large sample size, multicenter randomized trials are still required.

TRIAL REGISTRATION

researchregistry6492.

摘要

背景

我们进行了一项随机临床试验方案,以评估依达拉奉治疗急性脑卒中的疗效。我们假设依达拉奉有益于改善急性脑卒中引起的神经功能缺损。

方法

该方案已通过承德医学院附属医院伦理委员会的审查和批准(0092-2394),每位参与者在参与前均签署了书面同意书,并全程遵循 SPIRIT 指南。患者纳入标准如下:头部 CT 或 MRI 在 72 小时内确诊为急性脑卒中(缺血性脑卒中或脑出血);年龄大于 18 岁;运动功能障碍;格拉斯哥昏迷量表评分大于 12。具有以下症状的患者被排除在外:并发严重并发症,如昏迷、药物过敏、精神障碍和其他严重的脑器质性病变。最终有 60 名患者纳入研究。对照组接受常规治疗,而治疗组在对照组常规治疗的基础上接受依达拉奉治疗。治疗后,测试并比较了两组患者的功能运动、生活能力评分、神经评分、治疗效果和不良反应的差异。

讨论

随着老龄化的加剧,急性脑卒中的发病率不断增加。脑损伤会诱导氧自由基的产生,氧自由基可以破坏脑细胞的细胞膜,最终损伤神经系统,导致脑损伤和脑水肿。依达拉奉是一种抗氧化剂和氧自由基清除剂,在清除氧自由基时可以抑制脂质过氧化。此外,它还可以引发神经细胞的抗炎保护作用,增加脑血流量,防止脑灌注不足加重向坏死发展,减少神经损伤,改善神经功能和预后。这是第一项评估依达拉奉治疗急性脑卒中疗效的随机对照试验。仍需要高质量、大样本量、多中心的随机试验。

试验注册

researchregistry6492。

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