Perinatal Stroke nthuav tawm raws li HIE: Cov Tswv Yim Kev Tshawb Fawb thiab Kev Tswj Xyuas Kev Sib Tw

POB ZEB:

Thaum kho hypothermia raug lees txais raws li tus qauv ntawm kev saib xyuas rau kev txhim kho cov txiaj ntsig ntawm lub paj hlwb rau cov neeg mob HIE, cov pov thawj ntawm nws cov txiaj ntsig rau kev mob stroke tsis muaj. Kev nthuav qhia Neurological ntawm HIE thiab neonatal stroke tuaj yeem nyuaj rau qhov txawv. Peb qhov kev soj ntsuam kev soj ntsuam ntawm cov me nyuam mos mob stroke qhia txog cov teeb meem hauv kev sib txawv ntawm ob pawg thiab mus txog qhov kev kuaj mob ntxov kom paub txog kev kho mob. Qhov kev soj ntsuam no sim ntsuas seb qhov kev kuaj mob antenatal sentinel, kev nthuav qhia kho mob, CFM, thiab cranial ultrasound pab qhov txawv ntawm ob pawg thiab seb puas muaj feem cuam tshuam rau kev kuaj mob ntxov thiab kev tswj xyuas.

Txoj kev:

A retrospective cohort study of term neonates >37 lub lis piam gestation yug thaum lub Tsib Hlis 2011 thiab Plaub Hlis 2020 ntawm ib lub koom haum tshwj xeeb NICU nyob rau sab hnub tuaj ntawm teb chaws Askiv nrog kev kuaj mob tseem ceeb ntawm tus mob stroke. Tag nrho ntawm 16 tus neeg mob tau txheeb xyuas qhov uas 8 tau txias rau qhov kev kuaj mob thawj zaug ntawm HIE, thiab rov qab MRI kev kuaj mob ntawm neonatal stroke. MRI lub hlwb raug mob (1a rau 3) yog raws li National Institute of Child Health thiab Human Development Neonatal Research Network cais.

Nyem rau cistanche koob tshuaj rau neuroprotective ntawm Cistanche

TSEEM CEEB:

15 tus me nyuam mos muaj cov hlab ntsha nruab nrab ntawm lub paj hlwb, thiab ib tus me nyuam mos muaj lub paj hlwb thrombosis. Ntawm 8 tus menyuam mos txias, tsuas yog 3 (37 feem pua) ntawm cov menyuam mos txias ua tiav ob qho tib si Toby A thiab B. Cov menyuam mos uas tau txais kev kho mob hypothermia muaj feem yuav tshwm sim thaum pib qaug dab peg (5/8) dua li cov menyuam mos uas tsis tau txias (1/8) (p=0.019). CFM tau qhia txog kev qaug dab peg ib leeg hauv 14/16 (87.5 feem pua) ntawm cov menyuam mos. Tsuas yog 1 tus menyuam mos uas nyob hauv qab venous infarction nthuav tawm nrog ob tog qaug dab peg. Cov kab mob keeb kwm yav dhau yog ib txwm nyob hauv 8 (50 feem pua) ntawm cov menyuam mos. Tsis muaj kev sib raug zoo ntawm kev qaug dab peg thiab keeb kwm yav dhau. Cov me nyuam mos txias muaj feem ntau tuaj yeem muaj qhov txawv txav ntawm lub paj hlwb thaum yug los tab sis muaj qhov qaug dab peg qis thiab MRI raug mob ntau dua li cov menyuam mos uas tsis txias txawm tias qhov no tsis muaj qhov tseem ceeb. Cranial ultrasound nrhiav tau tsis tuaj los yog tsis yog tshwj xeeb.

NYEEM NTXIV:

Cov me nyuam mos uas muaj mob hlab ntsha tawg uas muaj qhov qaug dab peg thaum ntxov muaj feem yuav tau txais kev kho mob hypothermia txawm tias tsis ua tiav ob qho tib si Toby A thiab B. Kev ua xyem xyav ntxov los qhia txog kev tswj hwm tuaj yeem tau txais txiaj ntsig zoo dua los ntawm CFM thaum cov kev tshawb pom ntawm cranial ultrasound feem ntau tsis yog tshwj xeeb. Ib txwm CFM keeb kwm yav dhau los yog qhov txawv txav tsis zoo tom qab nrog unilateral qaug dab peg yog qhov qhia tau tias muaj mob stroke. Cov ntaub ntawv pov thawj ntawm kev ua tau zoo thiab kev qhia txog kev kho mob hypothermia hauv qhov chaw no tseem tsis muaj. Txoj haujlwm BAPM tshiab rau HIE nrog rau kev suav nrog CFM hauv kev xaiv cov menyuam mos uas tau txais kev kho cua txias yuav ua rau txo qis qhov tshwm sim ntawm cov menyuam mos uas muaj mob stroke tau txais kev kho mob hypothermia. Kev tshawb fawb yav tom ntej hauv kev nkag siab txog kev ua tau zoo ntawm kev kho mob hypothermia ntawm cov txiaj ntsig neurological hauv cov hlab ntsha neonatal yog xav tau.

Lub Neuroprotective Properties ntawm Cistanche:

Cistanche yog cov tshuaj suav tshuaj suav tshuaj uas tau siv rau ntau pua xyoo los kho ntau yam kab mob xws li kev xeeb tub, tsis muaj zog, cem quav, thiab kev laus muaj feem cuam tshuam. Nyob rau hauv xyoo tas los no, Cistanche tau nyiam cov neeg tshawb nrhiav vim nws cov nyhuv neuroprotective. Cistanche muaj ntau yam bioactive tebchaw xws li phenylethanoid glycosides, iridoids, lignans, thiab polysaccharides, uas tau raug tshaj tawm tias muaj ntau yam khoom siv tshuaj, suav nrog tshuaj tua kab mob, tshuaj tua kab mob, thiab tshuaj tiv thaiv apoptotic. Tsab ntawv xov xwm no yog txhawm rau tshuaj xyuas cov txheej txheem neuroprotective ntawm Cistanche thiab muab kev pom rau nws cov peev xwm kho mob rau cov kab mob neurodegenerative.

Cistanche tuaj yeem hloov kho lub cev tiv thaiv kab mob los ntawm kev txhim kho cov haujlwm ntawm cov neeg tua neeg lub cev thiab txhawb kev tsim cov cytokines xws li IFN- , TNF- , thiab IL-2, uas muaj cov teebmeem neuroprotective (Ma li al., 2014). Cistanche tseem tuaj yeem tshem tawm cov dawb radicals thiab inhibit lipid peroxidation, yog li txo qis oxidative kev ntxhov siab vim neuronal puas (Chen li al., 2018).

Lub ntsiab bioactive tebchaw nyob rau hauv Cistanche yog phenylethanoid glycosides, uas tau pom tau hais tias yuav siv cov neuroprotective teebmeem. Piv txwv li, acteoside, ib qho phenylethanoid glycoside cais tawm ntawm Cistanche, tiv thaiv neurotoxicity tshwm sim los ntawm -amyloid (A) thiab glutamate hauv kab lis kev cai hippocampal neurons (Yi li al., 2013).

Ob peb lwm phenylethanoid glycosides tau tshaj tawm tias muaj cov teebmeem neuroprotective. Piv txwv li, echinacoside tiv thaiv neuronal apoptosis thiab attenuates hippocampal raug mob los ntawm cerebral ischemia-reperfusion hauv nas (Zhang li al., 2013). Ib yam li ntawd, salidroside, lwm phenylethanoid glycoside, tiv thaiv dopaminergic neurons los ntawm rotenone-induced toxicity nyob rau hauv tus nas qauv ntawm Parkinson tus kab mob (Wang li al., 2016).

Lub luag haujlwm ntawm CistAnche Polysaccharides hauv Neuroprotection:

Cistanche polysaccharides yog lwm chav kawm ntawm bioactive compounds hauv Cistanche uas tau tshaj tawm tias muaj cov teebmeem neuroprotective. Piv txwv li, Cistanche polysaccharides tiv thaiv apoptosis tshwm sim los ntawm A thiab H2O2 hauv kab lis kev cai PC12 hlwb (Wang li al., 2015).

Ntxiv mus, Cistanche polysaccharides tuaj yeem txhim kho qhov kev qhia ntawm lub hlwb-derived neurotrophic factor (BDNF) hauv kab lis kev cai neurons thiab hauv hippocampus ntawm nas kho nrog scopolamine. Cov tshuaj no cuam tshuam kev kawm thiab kev nco (Liu li al., 2015). BDNF yog ib qho tseem ceeb ntawm cov neurotrophic uas ua lub luag haujlwm tseem ceeb hauv kev muaj sia nyob neuronal, sib txawv, thiab plasticity.

Cistanche polysaccharides tseem tuaj yeem qhib txoj hauv kev PI3K / Akt signaling, uas phosphorylates thiab ua kom cov dej ntws qis qis glycogen synthase kinase 3 (GSK-3), ib qho tseem ceeb enzyme koom nrog hauv neuronal ciaj sia taus thiab synaptic plasticity (Zhou et al., 2018) . Inhibition ntawm GSK-3 kev ua haujlwm tuaj yeem tiv thaiv kev puas tsuaj rau neuronal thiab txhim kho kev paub txog kev ua haujlwm hauv tsiaj cov qauv ntawm Alzheimer's disease (AD) (Llorens-Martín li al., 2014).

Lub Mechanism ntawm Cistanche's Neuroprotective Effect:

Cov kev tshawb fawb tsis ntev los no tau nthuav tawm cov txheej txheem hauv qab ntawm cov txiaj ntsig neuroprotective ntawm Cistanche. Cistanche tuaj yeem qhib Nrf2/ARE teeb liab txoj hauv kev, uas yog txoj hauv kev tseem ceeb rau kev tiv thaiv cellular tiv thaiv oxidative kev nyuaj siab thiab mob (Zeng li al., 2020). Thaum ua kom muaj zog, Nrf2 hloov mus rau lub nucleus thiab khi rau cov tshuaj tiv thaiv antioxidant (ARE) hauv thaj tsam txhawb nqa ntawm cov hom phiaj, xws li heme oxygenase-1 (HO-1), NAD(P)H: quinone oxidoreductase 1 (NQO1), thiab glutathione S-transferase (GST).

Cov noob no encode enzymes koom nrog hauv kev tiv thaiv antioxidant, xenobiotic metabolism, thiab inflammatory teb. Kev ua kom txoj hauv kev Nrf2/ARE tuaj yeem txhim kho qhov kev qhia ntawm cov enzymes no thiab tiv thaiv cov neurons los ntawm oxidative kev ntxhov siab vim kev puas tsuaj thiab kev raug mob vim raug mob (Cui li al., 2019).

Cistanche tseem tuaj yeem cuam tshuam kev ua haujlwm ntawm microglia, uas yog lub cev tiv thaiv kab mob hauv lub hlwb uas ua lub luag haujlwm tseem ceeb hauv neuroinflamation. Thaum ua kom muaj zog, microglia tuaj yeem tso tawm cov cytokines pro-inflammatory, xws li TNF- , IL-1 , thiab IL-6, thiab reactive oxygen hom (ROS) uas tuaj yeem ua rau cov neurons thiab ua rau cov neurodegeneration ntau dua (Block li al. , 2007).

Cistanche tuaj yeem cuam tshuam qhov ua kom microglia los ntawm kev txo qis kev qhia ntawm tus xov tooj zoo li receptor 4 (TLR4), ib qho receptor uas kho qhov ua kom microglia los ntawm ntau yam stimuli, xws li lipopolysaccharide (LPS) thiab A (Yang li al., 2017). Cistanche kuj tseem tuaj yeem cuam tshuam qhov ua kom NLRP3 inflammasome, ntau cov protein ntau uas pib ua kom loj hlob thiab tso tawm ntawm IL-1 thiab IL-18, ob lub cytokines pro-inflammatory koom nrog hauv neuroinflammation (Jiang li al., 2020) .

Hauv kev xaus, Cistanche yog ib qho khoom cog lus ntuj nrog cov teebmeem neuroprotective uas tuaj yeem txo cov kev ntxhov siab oxidative, o, thiab apoptosis hauv neurons. Cov txheej txheem hauv qab no suav nrog kev hloov pauv ntawm lub cev tiv thaiv kab mob, tshem tawm cov dawb radicals, ua kom muaj cov kab mob neurotrophic, thiab cov kev cai ntawm kev taw qhia txoj hauv kev uas tswj cov cellular metabolism, redox tshuav nyiaj li cas, thiab inflammatory teb.

Qhov kev tshuaj xyuas no qhia txog qhov muaj peev xwm kho tau ntawm Cistanche rau cov kab mob neurodegenerative, xws li AD, Parkinson's disease, thiab mob stroke. Txawm li cas los xij, kev tshawb fawb ntxiv yog xav tau los qhia txog cov tshuaj pharmacokinetics thiab bioavailability ntawm Cistanche hauv tib neeg thiab tshawb nrhiav nws cov txiaj ntsig zoo nrog lwm cov tshuaj lossis tshuaj ntxiv.