Ebrahimi Sedigheh, Ashkani Esfahani Soheil, Ebrahimi Alireza
Department of Medical Ethics, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Iran J Child Neurol. 2022 Winter;16(1):77-84. doi: 10.22037/ijcn.v15i4.29816. Epub 2022 Jan 1.
Perinatal hypoxic-ischemic brain injuries have been a major cause of mortality and neurodevelopmental morbidities in newborns. Citicoline and Piracetam have been used as nootropic agents in a number of studies. In this investigation, we aimed to determine the effects of these agents solely and in combination in hypoxic-ischemic brain damage in rabbit neonates.
MATERIALS & METHODS: Hypoxic-ischemic brain damage was induced by the occlusion of both uterine arteries of dams for eight minutes. The subjects were randomly divided into five groups as follows (n=6 per group): control group without hypoxia (C1), control group with hypoxic-ischemic damage (C2), the third group (P) received Piracetam (100 mg/kg), the fourth group (T) administered with Citicoline (250 mg/kg), and the fifth (PT) received both. The preventive effects of the two drugs on hypoxic-ischemic brain damage were microscopically investigated by the rates of damage to the hippocampus.
Neuronal destruction rates in C1, C2, P, T, and PT were 4%, 45%, 37.5%, 12.5% (P=0.01 vs. C2), and 20% (P=0.03 vs. C2), respectively. The total means of hypoxic-ischemic damage, cell edema, neuronal degeneration, and eosinophilic degeneration were lower in the T group compared to C2 (P<0.05).
According to our results and previous findings, Citicoline as a treatment for hypoxic-ischemic brain injuries could be beneficial, and it has priority over neuroprotective agents like Piracetam. Moreover, the combination of Citicoline and Piracetam showed no superior effect in contrast with Citicoline alone. However, experimental studies on larger populations and clinical trials are highly suggested.
围产期缺氧缺血性脑损伤一直是新生儿死亡和神经发育疾病的主要原因。在多项研究中，胞磷胆碱和吡拉西坦已被用作益智药。在本研究中，我们旨在确定这些药物单独使用和联合使用对新生兔缺氧缺血性脑损伤的影响。
通过阻断孕兔双侧子宫动脉8分钟诱导缺氧缺血性脑损伤。将实验对象随机分为五组（每组n = 6）：无缺氧对照组（C1）、缺氧缺血损伤对照组（C2）、第三组（P）接受吡拉西坦（100 mg/kg）、第四组（T）给予胞磷胆碱（250 mg/kg），第五组（PT）接受两者联合使用。通过海马损伤率显微镜观察两种药物对缺氧缺血性脑损伤的预防作用。
C1、C2、P、T和PT组的神经元破坏率分别为4%、45%、37.5%、12.5%（与C2组相比，P = 0.01）和20%（与C2组相比，P = 0.03）。与C2组相比，T组缺氧缺血损伤、细胞水肿、神经元变性和嗜酸性变性的总均值较低（P < 0.05）。
根据我们的研究结果和先前的发现，胞磷胆碱作为缺氧缺血性脑损伤的治疗药物可能有益，并且它比吡拉西坦等神经保护剂更具优势。此外，与单独使用胞磷胆碱相比，胞磷胆碱和吡拉西坦联合使用并未显示出更好的效果。然而，强烈建议对更大规模人群进行实验研究和开展临床试验。
