inosine-diphosphate and Brain-Infarction

To compare clinical and morphological results of treatment of ischemic stroke in three groups of patients which differed by the forms and duration of an antioxidant therapy.. A randomized clinical trial was performed in 8 vascular centers of the Russian Federation in 2010-2014. It included 373 patients with ischemic stroke in the carotid territory. Patients were randomized into 3 groups to receive different regimens of antioxidant therapy as an adjunct to standard therapy: control group (ascorbic acid; 132 patients); cytoflavin (20 ml per day for 10 days; 133 patients); cytoflavin (the dose was decreased to 10 ml per day from 11th to 20th day) (108 patients). Patient's condition was assessed in 1, 10 and 21 day by a complex of clinical, laboratory and instrumental methods.. The analysis of CT in 1th and 21th day revealed a significant 1,5-1,7- fold decrease in the cerebral ischemic lesion in both groups treated with cytoflavin with no significant morphologic changes in the ascorbic acid group. The percentage of patients with ischemic lesion, increased during days 1-21, was 2-fold higher in the ascorbic acid group compared to cytoflavin groups. Morphologic changes were correlated with clinical variables and outcome. In patients with ≥14 points on NIH scale on admission, prolonged 20 day cytoflavin therapy was associated with a more prominent improvement of neurologic, functional and cognitive status compared to 10-day cytoflavin infusion. No differences in clinical variables were observed in patients with mild symptoms (<14 points on NIH scale on admission) receiving cytoflavin for 10 and 20 days.. Цель исследования - оценка антиоксидантной терапии (аскорбиновая кислота - АК, цитофлавин), назначаемой в составе стандартной схемы лечения по клиническим и морфологическим данным при инфаркте головного мозга. Материал и методы. Исследование проведено в период 2010-2014 гг. в 8 сосудистых центрах Российской Федерации. Были обследованы 373 пациента острым ишемическим инсультом в каротидном бассейне. Первую группу составили 132 пациента, получавшие 5% раствор АК в суточной дозе 20 мл, во вторую группу вошли 133 пациента, получавшие в качестве антиоксиданта цитофлавин в суточной дозе 20 мл в течение 10 дней, третью группу составили 108 пациентов, которым терапия цитофлавином была продолжена до 20 сут, при этом в период 11-20-е сутки заболевания доза препарата была уменьшена до 10 мл. Оценка состояния больных проводилась в динамике на основании комплекса клинических, лабораторных и инструментальных методов. Результаты и заключение. При анализе результатов рентгеновской компьютерной томографии, проводимой в 1-е и 21-е сутки лечения, было установлено, что назначение цитофлавина приводит к достоверному регрессу объема церебральной ишемии в среднем в 1,5-1,7 раза. В группе лечившихся АК значимых морфологических изменений не зарегистрировано, при этом среди лечившихся цитофлавином в 2 раза сократилась доля больных, у которых объем ишемии мозга возрастал в период 1-21 сут. У пациентов с первоначальной оценкой не менее 14 баллов по шкале NIH терапия цитофлавином в течение 20 дней способствовала более выраженной положительной динамике неврологического, функционального и когнитивного статуса, чем при 10-дневных инфузиях.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Brain Infarction; Drug Combinations; Energy Metabolism; Female; Flavin Mononucleotide; Humans; Infusions, Intravenous; Inosine Diphosphate; Male; Middle Aged; Niacinamide; Russia; Succinates; Tomography, X-Ray Computed; Treatment Outcome

To determine the optimal duration of energy corrective treatment of ischemic stroke (II) with cytoflavin or ascorbic acid.. A multicenter randomized clinical trial included 185 patients, aged 40-75 years. Patients were randomized into 3 groups: the control group (n=64) received ascorbic acid; cytoflavin group 1 (n=72) was treated for 10 days and cytoflavin group 2 (n=49) for 20 days. In all groups, mean NIHSS score was 13, 42.2% of patients scored ≥14 and on admission, 42.2% of patients had consciousness impairment of different severity.. Cytoflavin treatment was more efficient than ascorbic acid that can be explained by different pharmacologic mechanisms. Treatment with cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25.2%, treatment with cytoflavin for 20 days - by 29.0%, which was associated with better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Prolonged treatment with cytoflavin in critically ill patients led to significant improvement in clinical and morphologic variables compared to the 10-day course. In patients with less severe condition comparable results were obtained.. Our data justify the need for personalized integrated antioxidant and energy correction therapy.

Topics: Adult; Aged; Antioxidants; Ascorbic Acid; Brain Infarction; Brain Ischemia; Drug Combinations; Female; Flavin Mononucleotide; Humans; Inosine Diphosphate; Male; Middle Aged; Niacinamide; Succinates; Treatment Outcome