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//
Julio J. Secades
,
2010
Revista de Neurologia // Rev Neurol 2011; 52 (Suppl 2): S1-S62
, .. ,
. // Julio J. Secades
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2
2010
1
.
.
-
3
4
4
7
16
20
22
23
23
23
23
24
24
24
25
27
28
28
32
41
47
49
51
52
.
// Juli
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: , 2010
. // Julio J. Secades
: ,
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2
2010
1
, , , , , [1-3].
( )
,
(, ), ()
[3,4].
, , .4 , . , , , , [1]. [1,5].
, ,
[1,6]. ()
, [7-9]
[10].
- , [11-20] , [21,22] [23-26]. ,
, [37-39]
[53] , , ( ), [32,40-52] , [54,55,57]
[58,59]. , ,
,
[56-64]. , , /
;
,
[65-70].
(CDP- ) ,
, , ( 1); 2-4- [71]. CDP-
, [4,72-85]
[75,86-95]. 2, CDP- . ,
,
.
. 1. CDP- ()
.
// Juli
Julio
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o J.
J. S
Secades
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: , 2010
: , 2010
S-
Diglyceride
Phosphatidylcholine
(
)
. 2.
,
,
, , ,
, .
Mykita . [98] , .
, . ,
.
Yasuhara . [99,100] ,
( ) , , , .
Marti-Viano .[101] , , . , , , , ,
. ,
, 2
,
.
- () Ogashiwa .
[102]
,
60 / (p<0,05). ,
Watanabe . [103] ,
,
.
. // Julio J. Secades
: ,
20
2
2010
1
Alberghina .
[11] ,
A2 . . Arrigoni . [104] , A 2, . , Freysz . [105] , A1 A2,
() ,
, . Massarelli .
[106] A, Alberghina
Giuffrida [11], Arrigoni . [104], Freysz .
[105]. Kitazaki . [107],
2 .
A2 [108].
Algate . [109]
.
, , ,
,
. , , ,
-
, , .
Hayaishi
[110] Kondo [111],
, .
Tsuchida . [112] 3H- ,
, -
, ,
.
Boismare [12,113]
( ).
.
( ), ,
. , , .
.
Clendenon . [114] , Mg2+ - , .
Cohadon .
[14,15,115] ,
20 // -, Na+/K+ -, - , 4 , 10 .
, : , .
Lafuente Cervos-Navarro [116,117]
, , . , , -
.
// Juli
Julio
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o J.
J. S
Secades
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: , 2010
: , 2010
, .. . , CDP-
Na+/K+.
Majem . [118] ,
, ,
. - ,
- -,
, .
,
.
Roda [119] , ,
,
,
, ,
, , , . , ,
, : ,
, .
Dixon . [120]
,
, . 100 /
18 .
. , ,
, .
-
. , ,
, , (39,663,2 30,262,9 ;
p<0,01). , , , . ,
(p<0,014),
(p<0,036), , 3 , , , . , , , .
Plataras . [121]
(0,1-1 )
, Na+/K+- Mg2+-- , .
1-3 , 20-25% (p<0,001)
Na+/K+- - 50-55% (p<0,001), Mg2+-- .
,
Na+/K+-
, ,
.
Baskaya . [122]
. (50, 100 400 /)
.
( )
. 50 / , 100 / -
. // Julio J. Secades
: ,
20
2
2010
1
,
. 400 /
. ,
, , .
Dempsey Rao [123] , 200400 /
,
, .
[124]. .
, 300 / 5 [125]. , , [126].
[127],
[128].
[129]. ,
[130].
, ,
[131].
in vitro , (..,
, ) [132].
, , ,
[21].
,
.
. Na+ Ca2+ , [6,28,32,36,108,133].
CDP-
, [32,134].
[4] , / .
Boismare . [135] ,
20 / / ,
.
[136] , ,
, , .
, , ,
. ,
.
// Juli
Julio
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o J.
J. S
Secades
ecades
: , 2010
: , 2010
,
[137] . . , , ,
.
Alberghina . [138] , ,
. , 100 / /,
10 [2-3H] [l-14C]
. , . , , ,
, ,
. [139] ,
, .
,
[140-159].
Horrocks . [140,143,145] , CDP-
,
.
,
, Trovarelli
. [141,142] , , , , , -
.
Suno Nagaoka [144] ,
5
. ,
.
, , 17422 /,
, 200 1000 / /,
1198 / 618 /, . ,
. Agut . [146]
190-200 14- 4 / (50 /) . 24
, 100 /.
,
. ,
, . Rao
. [150] ,
6- , 4
24 . , , , 3
. 6 808% CA1 , 656%.
[151] , ,
. ,
A2 ,
. ,
. // Julio J. Secades
: ,
20
2
2010
1
, [152-156]. ,
, ,
, - [157-158]. , ,
[159].
Tornos . [160] ,
. , 4 , , .
[161]
[162], .
Narumi and Nagaoka [163]
.
30 .
1000 /
, ,
,
, .
24
. , 70-80%. ,
, ,
. 500 / ,
. , ,
.
Nagai and Nagaoka [164]
, 30
. 4 .
81% . 250 / / 2 3
, . ,
.
Hurtado . [165] ,
, .
+
1
+
0,2
50
100
150
200
(/ )
. 3.
,
. (200 1000 /)
10 . 5
.
. ap<0,05; bp<0,001
.
// Juli
Julio
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o J.
J. S
Secades
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: , 2010
: , 2010
10
100
a
75
50
25
0
0
10
20
30
(SHAM)
b
+CDP
+.-
120
% Contralateral swing
,
, , , ,
.
. , EAAT2
,
, 4
[166]. [167] , , 24
, .
(staircase reaching test) (elevated body swing
test; EBST) , . ,
24 () 28 , (+CDP=87,06,6%
+.=40,04,5%;
p<0,05) EBST (+CDP=70,06,8% + .
=88,05,4%; ; p<0,05). ,
V
-. , , , . Zhao . [168] spatial learning
.
Kakihana . [169]
, 30
.
-
100
80
60
10
20
30
(SHAM)
+CDP
+.-
. 4.
(CDP-) ,
(a)
(b). (+CDP)
(+.-)
24
()
28 .
(EBST), .
. , n=16,
p<0,05 +.-
. , . [170]
. // Julio J. Secades
: ,
20
2
2010
1
,
, ,
. , Fukuda . [171].
Nagaoka [172] , . . (200-1000 / /), , . ,
.
, 500 / / , 40
. , ,
.
Saligaut Boismare [173] 1000 /
, (15 7180 ). - ,
, . -
, .
, ,
, , . ,
[174].
LePoncin-Lafitte . [97]
, -
. , , , . , ,
,
. Araki . [175]
, .
Aronowski . [176] (500 /)
,
30-120 . ,
, 15-
, 14 . (
) , , .
(101,611,4 3 103,313,6 3
), , ( 38,35,9 60,54,3
; p<0,05). , (8,50,7 10,14,0 ), , ( 41,94,6 72,924,5 ; p<0,05). , , ,
30-75
.
11
.
// Juli
Julio
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J. S
Secades
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: , 2010
: , 2010
Schabitz . [177]
( 2 ). 7
( : 0,3 /),
(100 //, /) (500 // /). , 2- .
-,
7- ,
. ,
,
. ( 5) 243,588,6 3
, 200,219,9 3 125,545,2 3 . (p<0,01).
, , , .
,
[178-181] [182185] . Andersen
3
350
300
250
200
150
100
50
0
100 /
500 /
. 5. (100 /)
(500 /) .
.
(p<0,01)
,
12
. [178]
,
(), . (n=19), ,
6 : (1) , (2) 250 /, (3) 500 /
, (4) 5 /, (5) 5 / + 250
/ (6) / + 500 /. (5 /
45 , 45-
).
4 .
4 ,
.
, ,
(6). 41,2% (5,9-87,0%). 30,4% (1,0-70,0%, .) 2 22,2%
(0,7-76,6%, p<0,05) 3. ( 4) 24,5%
(1,4-71,1%, ..), 13,5% (0,2-47,8%,
p=0,002) 5 29,2% (0,11-72,1%, ..) 6. ,
. Diez-Tejedor . [179-180]
, ,
,
. Shuaib . [181] , . 2 . 72 . 33,19,7%. , , : 300
/ /, 300 / /
3 . -
. // Julio J. Secades
: ,
20
2
2010
1
p < 0,01
+
500 +
p = 0,02
250 +
p = 0,054
500
250
10
15
20
25
30
35
40
(% )
. 6. ()
. 250: 250 /; 500:
500 /; : , 5 /
191]; ,
(..,
,
) [192]. [159] , ,
.
,
[193-196].
Hamdorf . [197] 48 103 , .. .
(15% O2). [198] , 5 . , , , .
,
,
. ,
, . Lee . [199] , .
, Masi . [200] ,
,
. Pinardi . [201]
- , ,
, .
1 / 30 . , -
13
.
// Juli
Julio
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J. S
Secades
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: , 2010
: , 2010
,
.
30 -
, .
, . , ( ). , ,
, /
.
Clark . [202] () , . 68
. 500 / /
24 48 .
28 . 54 , ,
. , , , ,
(10,42,0 12,12,4; p<0,01).
,
, , (13,85,8 3; 10,84,3%
),
(17,07,1 3; 13,35,1%) (p<0,05). , .
, ,
[203-207], [208,209].
[210], . - . 4 : +A, 500 / /
14
24 1 23 ; A, 500 / / 30 23 ; C,
/; D,
. 12
( 7
) 24 ( 7 ). 1, 2,
3, 6 8 . - --
(PARP).
PARP , 12 24 .
12 24 , 3 24
PARP ( 7),
+A, . , ,
[211], , [128,187,212-216].
Fiedorowicz . [217] , .
Giralt . ,
. , [218], , , ,
300-500 / [219].
Drago . [220], (), , , .
,
(8),
, -
. // Julio J. Secades
: ,
20
2
2010
1
12
24
35
25
b
b
15
b
a
a
c
( + A)
( A)
( + A)
( A)
. 7. -- (PARP)
-
1224 . ap<0,05; bp<0,025; cp<0,0001
?
?
Ca2+/Na+
Activation of phospholipases
NO-
(-)
. 8. . ,
15
// Juli
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J. S
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Julio
Secades
: , 2010
: , 2010
, , , , .
, [34,25,221,222]. , , [223].
, .
.
.
Martinet . [224] ,
3H-
3H-, ,
3H-, 3H- 3H-.
. ,
.
, , , . , ,
( 1 ) - (
1 ) . 9,
.
. , -
16
(%) b
20
(%) b
(%)
20
20
a
10
10
10
0 1/2 1
2 .
2 .
0 1/2 1
(%)
20
(%)
20
10
10
0 1/2 1
2 .
0 1/2 1
2 .
0 1/2 1
2 .
. 9. (30 / /)
.
,
. ;
; ; ap<0,1, bp<0,05;
c
p<0,01
, , . , ,
. ,
, . ,
ex
vivo [225,226]. , , , , .
,
.
. // Julio J. Secades
: ,
20
2
2010
1
Saligaut . [227] , , , . ,
, . ,
,
,
. ,
. , , , , . , ,
. , , [228] , , , . , .
, ,
, . , ,
, .
, [229]. ,
. Saligaut . -
17
// Juli
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J. S
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Julio
Secades
: , 2010
: , 2010
, . , , . Agut . [234] , ,
D2 . , - ,
,
. 100 / ,
30 , 0,15 / /.
30 1 / .
30, 60 90 . , .
100 // 5 .
, , .
1. , .
90 .
,
100 /,
, , , .
, ,
, ,
, .
,
,
, . ,
,
, , .
120
, (2// 7 ) [235].
, , , , , . ,
1. ,
n=20; ap<0,05; bp<0,01
18
+30
+60
+90
(10 / )
(1 / /)
(0,5 / /)
1,190,23
0,610,17
0,190,15
(0,1 / )
(1 / /)
(0,5 / /)
1,390,18b
0,740,17a
0,380,14b
(10 / 5 )
(1 / /)
(0,5 / /)
1,130,22
0,630,25
0,260,12
(0,1 / 5 )
(1 / /)
(0,15 / /)
1,110,25
0,700,19
0,410,12b
. // Julio J. Secades
: ,
20
2
2010
1
, , , , . -
[236],
( 50 /) ,
. , , ,
, , .
Shibuya . [237] 500 / / 1 (p<0,05). ,
Stanzani [238] , , ,
, , . Porceddu Concas [239] , , / .
,
, 6- [240],
-4-- (MPP+) [241,242] [241]. Miwa . [243] ,
,
.
, .
Gimenez . [244]
, -
,
. , , ,
Petkov .
[245]. , Petkov .
(, ) , , , , , [246]. ,
,
, . ,
,
, , . , [247]. ,
, , . , Lopez Gonzalez-Coviella
. [248] , 3--4 , , , . ,
()
(- , GABA) [249].
.
[250] [251],
19
// Juli
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o J.
J. S
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.
Julio
Secades
: , 2010
: , 2010
.
, [252],
[253,254]. ,
[255]. , - [256-258]
[269-261] . Ilcol . [262] , -
, . Yilmaz . [263] ,
, () ,
,
- .
, [264,265], GABA- [266], Na+/K+ - [267].
, ,
. ,
. ,
,
.
, . , ; ;
; , GABA-.
20
,
, ,
,
. ,
. ,
Saligaut Boismare [173]
, .
300 // 12 ,
5 .
, , , 0,5 / 30
, , .
. . ( ) . , ,
, .
, [199].
Drago . [268] 24-
- , ,
10-20 // / 20 .
, (), ,
. -
. // Julio J. Secades
: ,
20
2
2010
1
,
.
. , ,
,
, ,
.
Petkov . [269]
,
, . Mosharrof . [270] , 100 / , , , 50 / 500 /,
. , . , ,
[271]. , Alvarez . [272] ,
, . Bruhwyler . [273]
,
, , ,
. ,
. , [274],
[275], , [276].
, , . , ,
, . [1,4,5]. De Medio . [277]
,
. in
vivo 12- .
(
) (2-3H) (Me-14C),
, , 1 . 10 ,
.
10 , , . , , . , .
, 3H/14C
, . Lopez Gonzalez-Coviella . [278]
.
500 //: 3-
27 , 12- 90, 42 3 ,
, ,
. 27 19% 20%, ,
- 18%, ( 10).
12- , 3 . ,
, -
21
JJulio
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J. S
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Secades
// Juli
: , 2010
, 2010
250
200
150
100
50
0
. 10.
30- ,
(500 //)
27. ap< 0,05; bp<0,01
22
300 , , 2
. , .
,
,
[302]. Tornos
. [303]
,
.
.
, 2 / , ,
.
10 39%. , ,
2 /
. // Julio J. Secades
: ,
20
2010
1
,
. , , .
, . Patt
. [304] , ,
, ,
,
. Petkov .
[305] ,
-
,
, ,
[306,307].
[308].
. (LD50) , 4,6, 4,15 1,95 /, [309,310],
27,14 / 18,5 / [311].
44 , ;
, ,
, , - [312,313]. ,
,
. 2000 / 14 [314].
2 // 4,5
, . 2 [311]. 1 /
4 [310].
1,5 // 30
, , [315].
(1,5 // 6
)
(1 // 12 ) ,
[310,316].
300-500 //
3
, (
) [313]. 90-
100, 350 1000 // . , (350 1000 //)
( ). ( 1000 //
) ( 100 350 /
/, 1000 //). (
) (
1000 //) ,
.
( )
/ .
, ,
, [314].
23
JJulio
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J. S
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d s
.
Secades
// Juli
: , 2010
, 2010
-
800 / , ..
7 18 . 29- , . . , 10% , , ( ).
Lopez Gonzalez-Coviella .
[318]
,
,
, , . 2 2 48%, 136% (11). , 2
2 , ,
30
(-14C) 4 /
[317].
, 10 , 2.
, , , , , 72 ,
.
()
25
20
15
10
5
0
4
6
()
10
12
. 11.
2
2. -14C- 4 /
. ( ..)
24
10 .
0,260,12
3,050,24
20 .
0,400,02
2,590,31
30 .
0,740,01
1,470,22
1,320,40
1,400,02
2,330,63
2,840,02
3,310,86
2,500,05
3,570,88
2,771,00
4,170,83
3,370,31
4,180,03
3,680,02
3,810,73
24
2,480,40
3,120,19
. // Julio J. Secades
: ,
20
2010
1
()
30
25
20
15
10
5
0
0
()
,
6
(13). ,
, ,
, .
, , , [320].
. 12.
2
30% , 4 ,
6 ( 12) 5 (p<0,001).
[319]. , 3 500 30 ,
, (-14C, 5-3H)-,
.. ,
[321,322]. 30
. 48
. 2
10%
160
140
5
120
4
100
80
60
2
40
1
20
0
0
30
()
()
- ()
. 13. , ()-
(3 /500 )
25
// Juli
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J. S
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.
Julio
Secades
: , 2010
: , 2010
. ,
48
2,5% 14C
6,5% 3H.
2%
.
, . 14 , , . . 10 ,
a
3
1
3/14
(%)
14
30
20
10
10
30
20
40
50
b
3
2
3
3/14
(%)
14
2
1
10
20
20
30
40
40
48
.
0,5, 1, 4 48
. , 3H,
, .
, 14C, ,
, 4 14C- 14C- 26,4% 24,2%, , , 14C. 48
, , . ,
48 . 15, 5 , .
(-14C) [323-327]. , , 24 ,
,
[323].
-, , -
50
(%)
14
30
1
3/14
(%)
14
20
5
0
20
40
10
40
20
0
0
20
40
()
0
0
10
20
30
40
50
. 14. (a),
(b) (c)
2 /.
10
26
14
. 15. C-
.
3 ,
% , 14C
. // Julio J. Secades
: ,
20
2010
1
.
, 10 [324], , .
5 24 [325].
24 .
(-14C)
- [326]. 62,8%
, , , , ,
. ,
Aguilar . [327], , .
, ,
, .
,
[319,328,329].
CO2 [330].
16 5 14C- . 3
.
: , 36 , , ,
.
CO2,
15 ,
.
25
20
15
(%)
10
CO2
. 16.
(% ) 5
14C-.
6
3. 14C- .
6
CO2
(% /)
1,220,59
0,1590,084
0,0210,008
()
1,600,73
1,30,8
5618
2,580,60
0,2790,055
(% /)
6,621,28
0,1070,017
56,2233,39
71,0858,16
19,396,63
(% /)
0,0300,049
0,0130,006
0,0390,014
27
JJulio
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J. S
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d s
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Secades
// Juli
: , 2010
, 2010
, () , . ,
.
,
- ().
1967 Moriyama . [331]
25
. , 70%
,
.
22 , , Ayuso Saiz
[332] ,
. , , 4 , , .
De la Herran . [333] 50 ( 32 ), , . 34% 48
, 66%
. , , ,
28
.
Carcassonne LeTourneau [334] 43
,
, .
, , , , , ,
.
Espagno . [335] 46 ,
.
, 22
250 /
20 , 24 . , (p<0,05),
(
) . 75,2% (>15 ) / . ,
15 31% ,
/ 12,5% . ,
-,
.
Richer
Cohadon [336] 60 2
,
, . , , 60- , (p<0,01) . 90
(p<0,04) . . , 60 -
. // Julio J. Secades
: ,
20
2010
1
(p<0,06).
, ,
. .
Lecuire
Duplay [337] 25
750 / 3 / . , ,
. 10 , 20 . 10 -
50% , 18% , . , , ,
,
, . 154
[338],
,
, . Lecuire
. [339] , (6 /)
(750 /) 40 ,
, 75%
33% .
Cohadon .
[16,340] 60 , , ,
. 750 / -
6 , 20 . .
6 . 15 , (p<0,01),
( 17). . 120 84% 62,5%
; 60- (p<0,01).
4
(Glasgow Outcome Scale, GOS). .
, , , .
Deleuze . [341] ,
, /. .
25
20
15
(n)
10
5
0
15
60
90
120
. 17. ; p<0,01 60
4.
(Glasgow Outcome Scale)
I
II
III
IV
12
11
29
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
Ogashiwa .
[102] 101
( 20% )
(General Recovery
Rate), (Principal Component Analysis
Score). , ,
, , 60 3 .
( ) [342,343].
Ramon Cajal 100 , ,
100 ,
[344].
600-1200 / ,
300-900
/ .
, ,
(WAIS) . ,
, ,
.
,
, Raggueneau . [345] 921 , ..
(GCS) 8. 219
, 2 .
, , GCS 6-7 ( 18).
,
, .
, -
30
10
(n=219)
20
30
40
50
(n=702)
. 18.
. (%).
a
p<0,001 ,
( ) - .
Calatayud . [346] 216 GCS 5 10; 115 . 4 /. , (p<0,05) (p<0,001) (
GCS 5 7 ), , , , ,
( 5).
Lozano [347] 78 GCS 5 7
.
5.
(Glasgow Outcome Scale, COS),
(p<0,05)
GOS
77
51
II
19
31
III
IV
18
10
. // Julio J. Secades
: ,
20
2010
1
. , . 39 2 3 6 / . 14
(19).
,
, (p<0,005). . 28,71821,6
37,32335,22 , (p<0,001).
, GOS,
. , ( 6).
Levin [348] 14
.
, , , . ,
1 , , , , . 20
30
0
25
3
(n)
. 20.
1 .
,
20
(n)
15
10
5
0
. 19. 14 (p<0,005)
6.
(Glasgow Outcome Scale, COS),
( )
GOS I
15
11
GOS II
GOS III
GOS IV
GOS V
1 . , , ,
, . 1
. ,
[349] .
, LeonCarrion . [350-352], . 7
1 133Xe. -
31
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
,
48 , ,
, 1
. , . 10 2 .
1 / 3 , , . 7.
.
, , ,
GCS 5 7,
,
, ,
[353].
,
. [354].
, COBRIT
[355].
,
, [356]. , [357-362]. , , , , ,
[15,34-36,148,221,222].
, 1960- , [363,364].
, Hazama . [365], 165 . ,
1000 / 8 ,
,
, ,
.
64 Goas . [366] (750 //10 )
, 48 . 3 ,
(p<0,05), (p<0,03), (p<0,02),
7. (..)
A
( + )
95,605,73
97,602,19
82,0033,79
90,8020,57
88,408,65
96,801,79
89,6017,74
98,801,79
22,409,91
23,6011,01
24,8014,65
31,809,36a
8,203,63
9,406,95
8,805,45
7,203,70
62,8013,24
62,0011,58
63,2017,31
71,0012,98a
p<0,05
32
( + )
. // Julio J. Secades
: ,
20
2010
1
(p<0,01)
(p<0,05),
(51,6% ; 24,24% ) ( 21).
Boudouresques
. [367] 52 , 27
(750 / 10
) 25 .
10 , , , ,
.
66,7% ( 32,0% ; p<0,01), (82,6%
54,5% , ; p<0,04) - (83,3% 35,3%, ; p<0,01). .
(1 / 30 ) 33
Corso . [368] ,
76,5% , (p<0,01 ), - 70,6% (p<0,01 ).
Tazaki . [369] ,
, ,
10
(n)
15
. 21.
,
,
20
. 63 , 272 . 1 / () 14 .
(51% 33% ; p<0,05), (52% 26%; p<0,01)
(47% 24%; p<0,001). , , , (1%),
(8,1%). ,
. ,
[370-373].
Guillen . [374]
, ,
,
. Bruhwyler .
[375] Fridman . [376] ,
. , Alvarez Gonzalez
[377], .
-, Leon-Jimenez
. [378]
,
30 90 . 173 , 86
48
. 87 , ,
( 5 ), -
33
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
(NIH) (1 ) . . ,
30
(p<0,05 ). ( NIH, ,
<24 ,
)
90 (p=0,047) (
, p=0,001).
,
.
1997 [379]. , , 3 (500 , 1000 2000
) ,
. 259
24 . 4 ,
500,
1000 2000 / 6 .
6- 6 . 12 . ,
(NIH), (Mini-Mental State Examination, MMSE),
.
34
( , ),
( NIH) ( MMSE). NIH
12
(p<0,05). ,
85
100 , 39,1%
500
, 1000 2000 61,3%, 39,4% 52,3%, .
2,0 500 2,1 2000 .
1000
, ,
. 3,1 , 2,5 500 , 3,1 1000 2,6
2000 ,
500
(p<0,03).
, , .
,
, 500 .
, , , [380] 394 , () 24 , NIH 5 .
(n=127) 500 /
(n=267) 6 6 . 12
, (71 ). NIH
,
NIH <8 (34%
22%, .; p<0,01). ( 5 -
. // Julio J. Secades
: ,
20
2010
1
) ,
, .
, 95 12
( 40%, 40%)
( 18%, 17%).
, , (
NIH 8 ), , 95 12 (21% , 33% ; p=0,05), (.. NIH <8) . , ,
, . ,
.
, ,
ECCO 2000 [381].
899 (
NIH = 8),
24 .
2000 / (n=453) (n=446)
6
6 . NIH 7 12 . 51% 52%
NIH 7 ,
. ,
,
NIH
1 (40% 35%
; p=0,056), ,
95 (40% -
35% ; p=0,108). ,
(1) 20% 26%
( ; p=0,025).
, (3% 6% ; p=0,02). , , , (2,9% 1,8%
; .. 62,1%).
(Generalized
Estimating Equations, GEE), Tilley
. [382],
,
(.., 0-1 NIH, 0-1 >95 12 ).
, ,
19%
, 14%
(: 1,32; 95% : 1,03-1,69; p=0,03).
, .
() [383].
12 [379]. 3 4 ,
7 8 (p<0,01, NIH ). , , (.. - ), 100 , 500 / 6 [384].
24 -
35
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
, NIH 5 , -
1 120 3. (- , T2 , -
-)
1 12 .
12 ,
. 41 , ,
40 , ;
.
12- 180107%
3419% .
, 1 12 6,92,83
17,22,6 3
(p<0,01).
,
. ECCO
2000 [381]
[385],
.
2-
,
676 .
-
12 . 181 , 134 .
,
.. , .
(: 25,0 3 31,3 3
). , -
36
. // Julio J. Secades
: ,
20
2010
1
.
, , , [379-381,384].
1652 : 686 966 (381 500 /,
66 1000 / 519 2000 /). . 3 ( NIH 1 ),
1,22 (95% : 0,98-1,52) (p=0,07).
,
, 3
( 95) (:
1,26; 95% : 1,02-1,55; p=0,01)
, 1
(: 1,36; 95% : 1,06-1,74; p=0,01). , , ( NIH 8),
,
( 1).
1372
. -
( 8).
8. , 3
(n)
(n)
(95% )
NIH 1
1,372
1,34 (1,05-1,71)
0,020
1,351
1,45 (1,11-1,90)
0,007
95
1,372
1,28 (1,03-1,59)
0,003
: ; NIH
(National Institutes of Health Stroke Scale).
37
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
21,9
p = 0.0043
27,9
2000
15,7
p = 0.0872
500
20,8
()
20,2
p = 0.0034
25,2
()
0
10
15
20
25
30
(%)
. 22. (
, GEE)
3 .
NIH1, 95
1
: 611/1119 (64,6%),
561/844 (54,4%) (: 0,64; 95% : 0,530,77; p<0,00001). 4 (n >100 ),
: 574/1048 (54,58%), 500/773 (64,7%) (: 0,70; 95% : 0,58-0,85;
p <0,0003).
. , -
,
10-12% (.. 3
). , [390].
,
[392]. 2 ,
() [381,384].
(
%) ,
38
.. 3 .
111 , , 41 ,
500 /, 62 , 2000 /
6 . , , 84,741,2%, :
500 34,018,5%,
2000 1,814,5%.
, ,
[393]:
101,2-126,4 1 . , , , .
Sobrino . [394] , ,
,
- ()
. 48 12 . 2000 /
6 (n=26) (n=22). () ( )
7- . 7 . ,
, - (7,76,1 9,17,3
-; p=0,819). , , (),
, , , , (35,415,9 8,48,1
0,910,2 -; p<0,0001). (: 17,6; 95% : 2,3-137,5; p=0,006), (: 108,5; 95% :
2,9-1094,2; p=0,001)
. // Julio J. Secades
: ,
20
2010
1
(- 4). , . ,
, .
,
,
4191 , [395].
. (500-4000 /) 24 3736 ( ) 24 455 ( ); 6 .
(s-NIHSS),
(s-BI) (mRS) ,
6 .
, .
6 ,
s-NIHSS, s-BI mRS (p<0,05). 125 ,
12 , , 6 , .
(2000 /) (p<0,001).
s-BI
.
: 31
37 (0,73%). (8
37, 21,62%), -
(5 37; 13,5%). ,
.
() [396]. 38 40 85 , . 6
, ( ). (Glasgow Coma Scale) >8 NIH >7 .
1 /12
2 .
.
0-2
3 . 19 . .
( 4 ).
, 1
(mRS <3), 5 (: 5,38; 95% :
0,55-52; ..). , , , , , ..
, . ,
, . Eribal . [397]
RICH, . , , ,
. , , , ,
. 4 14
39
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
. 182 .
(56,9011,45
57,6111,83 ). ,
. ,
, (2,2% 0%, 9,2% 8,5%, 50,8% 31,9%, ). , 90 .
, ,
mRS (7,9% 13,4%, 18,2% 20,3%, 46,1%
33,8%); ,
90 .
NIH : 76,3% 75,6%, 93,9%
91,9%, 96,8% 94,3%, .
(11 ), (10),
32
52
29
C01016
113
193
42
CSSG18
151
267
77
CSSG19
20
CSSG
267
452
290
17
68
136
101
Tazaki Y et al
1100
(95% )
631
539
: 2 = 9,55; df = 4 (p=0,05); I2 = 58%
: Z = 3,51 (p=0,0005)
48
89
62
Chua R22
13
18
14
Secades H et al.25
107
(95% )
61
76
: 2 = 0,97; df = 1 (p=0,32); I2 = 0%
: Z = 2,06 (p=0,04)
12
23
20
Boudouoresques, Michel29
10
17
16
Corso EA et al33
15
3
25
Goan JV et al30
71
(95% )
61
37
: 2 = 2,18; df = 2 (p=0,34); I2 = 8%
: Z = 4,14 (p<0,0001)
1278
(95% )
729
676
2
: = 21,40; df = 9 (p=0,01); I2 = 58%
: Z = 4,91 (p<0,0001)
:
. . ,
BI mRS , 90-
, . , Iranmanesh Vakilian [398].
,
[399].
-, , Saver
[400] ,
( 23).
Ortega . [401] -
(%)
48
64
127
446
136
821
3,7
8,3
14,4
38,0
16,1
80,5
94
15
109
8,8
1,3
10,2
22
16
33
71
3,1
2,2
4,0
9,3
1001
100
; M-H, .
; 95%
0,01
0,1
10
100
. 23. . -
, , ,
.
C010: 010 ; ; CSSC: Citicoline Stroke Study
Group; df: ; .: ; M-H: -.
: J.L. Saver. Citicoline: update on a promising and widely available agent
forneuroprotection and neurorepair. Rev Neurol Dis 2008; 5:167-77
40
. // Julio J. Secades
: ,
20
2010
1
6 .
347 .
6 ( 3 ) 6 (7 ) . (2 /)
6 . (1 /) 6 . , ,
(: 1,725; 95%
: 1,090-2,729; p=0,019)
(: 1,728; 95% : 1,021-2,927; p=0,042). ,
6
.
, ,
,
,
[402-411] [412-413]. ICTUS [414-416] , .
,
,
,
. , , , . , (, ) (
, ) ,
[417].
, -
, .
.
,
, [418].
, [419-421]
[422], [423], [424-426] [427]. , [401].
, , Madariaga . [428] , ,
. Fassio . [429]
,
, .
[430-439]. , 30
Lingetti . [430] 83,3% . Stramba-Badiale Scillieri
[431] 24 20
500 /
(Fishback
Mental Status Questionnaire). Bonavita
. [432]
-
, , - . -
41
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
Lozano . [433]
2067 , 300-600 / 2 . - 9. Palleschi Capobianco
[434] Sandoz (SCAG) MMSE. 502 Schergna Lupo [435] , -
, ,
.
, , . Suryani
. [436] ,
( 10). ,
[437], , , [438,439].
9. (p<0,001
).
(n)
(%)
(%)
1521
38,2%
40,9%
1559
36,9%
39,7%
1504
41,3%
34,1%
1378
35,8%
32,9%
1614
26,0%
45,5%
1410
38,3%
34,5%
1132
40,0%
26,9%
1463
59,4%
31,3%
1234
35,2%
30,5%
1425
57,7%
31,2%
10. - ( ) , ,
, . ; ap<0,05; bp<0,01
42
(n=10)
1
(n=10)
2
(n=10)
3
(n=6)
14,64,6
19,65,6b
20,24,5b
22,86,0b
5,604,1
7,303,4b
11,37,1b
12,17,7b
6,104,4
9,603,8b
12,73,7b
13,64,8b
5,203,2
9,303,5b
11,73,4b
12,02,4b
2,50,9
1,000,9a
0,300,4b
0,300,5b
2,30,9
1,000,8a
0,200,6b
0,100,4b
. // Julio J. Secades
: ,
20
2010
1
, [440,441]. Ceda
. [442] ,
,
, .
.
(),
(
),
.
, , [443]. 33 1 /
28 . - -
, ,
, . Falchi
Delitalia . [444] Moglia . [445] ,
. Merchan . [446]
40 ,
1 / 60 ,
, .
Agnoli .
[447] 100
1 /
28 . , ,
, -
. , , , - .
Sinforani . [448], Motta . [449] Rossi
Zanardi [450]. [451-454].
, Eberhardt Derr [455] 11 ( 74,66,9 )
. , 600 / 5 ( )
5 . . 2, 7, 9 12 .
6 ( ,
, , NAS, NAB SCAG), 5 6 .
. 11 . , , .
, .
,
, .
, ,
, -
43
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
11. ,
I
II
47
31
21
52
73
69
71
83
67
76
67
87
NAS
57
41
44
69
NAB
63
57
48
67
SCAG
80
73
65
83
: NAS ; NAB
; SCAG .
.
Chandra [456] . 146 , 2 : 750 / , .
2 ,
10 . , , MMSE.
, , . 10 , ,
, .
Piccoli . [457]
92 , (1000 / )
4 1- . 46 ; . - ( ), SCAG ( ). ,
- (p<0,05),
44
, (p<0,05)
SCAG (p<0,02). , : , , .
, ,
Capurso .
[458] . 33 , (17 )
(16 ). 2- ,
28 , 1- . 1 / . , , , ,
. , . GBS (--)
. , , . ,
.
Cohen . [459]
. // Julio J. Secades
: ,
20
2010
1
,
.
, Tanaka . [460] ,
(1 / 1 ).
Lozano [461] ,
(GIAL) (,
)
.
314 ( 75,027,72 ), 600 / 1 . 41,1% , 39,5% 11,4% . 1, 3
12 ;
(MMSE) . MMSE
, , .
. ,
.
Corona . [462] ,
, ,
, ,
,
.
-
Cacabelos . [463] 40 , 4 : 1) 10
; 2) 10 , ; 3) 10 ,
; 4) 10 . 1 / . 3- .
MMSE ( 24),
( 25).
1 (-l) ,
,
. -l , ,
.
,
, ,
[464].
,
, [465],
- (-) [466].
, , , 1 / 12
30 [467].
(n=17),
,
E (APOE) 4 ( ),
ADAS ( ) (p<0,05). , .
45
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
MMSE
40
a
35
a
30
b
25
20
15
10
5
0
. 24.
(),
()
(),
().
MMSE.
a
p<0,02; bp<0,01
18
a
16
14
12
10
8
6
4
2
0
. 25.
(),
()
(),
().
. ap<0,02; bp<0,01;
c
p<0,05
Soto . [468] , (
) . Cacabelos .
[469] , ,
APOE 4.
,
, Fioravanti . [470]
46
, , , .
14 , , . , ; ( ), ( ). 7
20-30 , 6 , 4-
2-3 , 3 ,
12 . , , . ,
, , . 7 790 (384 406 ). () -0,09 (95% : -0,230,05), .. - .
- 10
924 (456 468
): 0,38 (95% : 0,11-0,65], . - 6
, 675 , ,
(: 0,22; 95% : 0,07-0,37). 5 8 844 (412 432 ). -
. // Julio J. Secades
: ,
20
2010
1
, ; , 3-5 . ,
, ,
. , .
,
[476].
, Ruggieri . [477] 28 600 / 10 . ,
- (Northwestern University Disability Scale, NUDS).
[478].
[479]. 28 , , 30 ,
2 , . , , .. , . 20 500
. 10 20, , .
, NUDS . ,
, . , .
Eberhardt . [480-482] ,
50%, , , , . ,
, ,
, ,
[483].
, Loeb . [484] 65
47
// Juli
ulio
o J.
J. S
ecades
.
Julio
Secades
: , 2010
: , 2010
1 / . 21 . 8 . 14 21
NUDS.
, , 45 , .
Acosta . [485] 61
, 48 . . 10- 500
.
14 .
, , ,
.
. , ,
36% ,
, , ,
, .
, 2 , 42,12%, , 2
19,08%. 20-100% 35,3% 2 25-33%
10% , 2 . ,
, , .
Cubells Hernando [486]
30 , -
48
. 500 /
2 , 1-
. 1 .
, .
,
(wearing-off ) (on-off ), .
.
1 . , , ,
. , ,
, . , , ,
. ,
, , , , , .
Marti-Masso Urtasun [487] 20 , 2 .
1 / 15 , 500 /
15 .
. ,
-
. // Julio J. Secades
: ,
20
2010
1
4,16% 7,26% 15
, . , .
, .
Garcia-Mas . [488]
, ,
() . ,
. , - -,
/,
, - -
, ,
-. 2 , , -. , .
, , ,
. .
, .
, Chinchilla . [489] 20 . , , (
2 ) -
,
. ,
,
.
Renshaw . [490-492] , , 4
500 2
. . , . , , [493].
, [494,495]. , ,
[496].
, [497-503],
[504-509]
[510].
Dinsdale . [511] 12
, (600 1 )
5 .
, , 4 5 , , , . ,
.
. , , .
49
// Juli
JJulio
ulio
uli
io J.
J. S
ecades
.
Secades
: , 2010
:
, 2010
12. ,
. (), 5% ;
..
58
9,95
108
13,69
0,036
38
6,52
77
9,76
0,032
86
14,75
135
17,11
..
78
13,38
113
14,32
..
228
39,11
286
36,25
..
81
13,89
105
13,31
..
81
13,89
117
14,83
..
46
7,89
72
9,13
..
57
9,78
74
9,38
..
182
31,22
241
30,54
..
65
11,15
92
11,66
..
186
31,90
261
33,08
..
53
9,09
91
11,53
..
88
15,09
131
16,60
..
71
12,18
119
15,08
..
55
9,43
90
11,41
..
235
40,31
298
37,77
..
103
17,67
145
18,38
..
48
8,23
78
9,89
..
111
19,04
157
19,90
..
180
30,87
227
28,77
..
45
7,72
74
9,38
..
55
9,43
82
10,39
..
79
13,55
112
14,20
..
49
8,40
74
9,38
..
75
12,86
105
13,31
..
89
15,27
111
14,07
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