胞磷胆碱注射液治什么病（胞磷胆碱钠注射用药有什么作用）

南昌大学**附属医院心内科郭治彬主任医师、教授、硕士生导师

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一、脑卒中后早期康复及二级预防的重要靶点：抗动脉硬化

一项由中国疾病预防与控制中心、美国华盛顿大学健康指标和评估研究所等机构的学者，对中国的疾病负担进行了全面评估，其研究表明，与全球235种死因中缺血性心脏病居首位不同，卒中成为导致中国人死亡的首位原因；第二位及第三位致死原因分别为缺血性心脏病(948,700人)和COPD(934,000人)。Gonghuan Yang, et al. Lancet 2013; 381: 1987–2015

卒中的一级预防是对未发生卒中的人群而言（高危人群和一般人群），通过早期改变不良的生活方式, 积极主动地控制各种危险因素, 从而预防或延迟卒中发生。Feldmann E, Daneault N, Kwan E, et al. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990;40:1541-5.

脑卒中后早期康复是二级预防的重要组成部分；诊断病因、风险评估并干预是二级预防的关键；对不同复发风险的患者进行分层，从而制定出针对性的个体化治疗方案，艾地苯醌和胞磷胆碱具有重要的作用。

二、艾地苯醌：

艾地苯醌（Idebenone ）是基于辅酶Q10结构开发的产品。

外源性的辅酶Q10透过不了血脑屏障，无法改善中枢神经系统疾病，艾地苯醌的侧链更短，没有异戊二烯单元，侧链末端增加了一个醇羟基，更易通过生物膜和血脑屏障，艾地苯醌较辅酶Q10抗氧化活性更强，强30-100倍。

线粒体是人体的“能量工厂“，辅酶Q10是人体自身所具有的重要物质，线粒体**的非蛋白氧化还原载体，辅酶Q10在细胞内分布为：细胞核占25-30%，线粒体占40-50%，微粒体占15-20%，细胞质占5-10%

艾地苯醌的药代动力学特点：

口服后15分钟，药物浓度即可在血液中达到峰值，半衰期为7.69小时；相较于各组织的分布，在脑组织中能更快的吸收和达到浓度峰值——为治疗脑血管疾病或神经退行性病变提供保障；肠道、肝脏、肾脏有良好的组织分布；经肾脏或肠道排泄，有研究证实在体内经18小时半衰期达双相消除；人体与动物试验均证实无长期体内蓄积效应

艾地苯醌的药理作用：

1、抗氧化作用：清除自由基；抑制脂质、蛋白质、DNA、微粒体等过氧化；降低缺血再灌注损伤；增强过氧化物歧化酶活性；

2、改善心脑的能量代谢：增加氧摄取分数；降低线粒体氧耗；促进ATP合成；降低乳酸、自由脂肪酸含量；提高葡萄糖利用率；

3、促进刺激神经生长因子合成：增加脑内额叶皮层和顶叶皮层刺激神经生长因子含量；

4、改善神经递质代谢：增强胆碱乙酰化酶活性；增加乙酰胆碱含量，降低胆碱含量，改善认知、调节5-HT含量，改善抑郁状况。艾地苯醌治疗脑卒中的同时，还可改善卒中抑郁症状，提高神经功能，疗效优于氟西汀。

5、抗炎：还原形式和氧化形式均抑制花生四烯酸代谢，还原形式更有效。

艾地苯醌临床应用—基于文献研究和临床实践：

1、作为一种强抗氧化剂和自由基清除剂，作用强于辅酶Q10，且可补充辅酶Q10，减少他汀类药物的不良反应；同时参与细胞线粒体代谢，对缺血的能量代谢和脑组织功能有保护作用。

2、血管性脑血管病造成的脑功能损害、卒中后神经功能损伤和卒中后抑郁、血管性痴呆、神经退行性疾病、认知障碍、阿尔茨海默病、帕金森病、遗传代谢性疾病、Leber遗传性视神经病变、Duchenne肌营养不良、弗里德赖希共济失调、线粒体脑肌病乳酸酸中毒和卒中样发作综合征。

二、胞磷胆碱

胞磷胆碱（Citicoline）也被称作二磷酸胞苷—胆碱、5‘- 焦磷酸胞苷—胆碱，是由核糖、胞核嘧啶、焦磷酸和胆碱组成的一种单核苷酸，是细胞膜磷脂生物合成的中间体及限速酶。在体内可促进细胞膜磷脂的生物合成，有效保护和修复受损的神经细胞膜。