Kev Kho Mob Hypothermia hauv Neonates Nrog Hypoxic Ischemic Encephalopathy: Hloov Kho Kev Ntsuam Xyuas Thiab Meta-analysis
Mar 10, 2023
POB ZEB:
Therapeutic hypothermia (TH) yog qhov kev cuam tshuam saum toj kawg nkaus rau cov me nyuam mos hypoxic encephalopathy [1]. Txawm li cas los xij, qhov kev sim HELIX tsis ntev los no tau tshaj tawm tias muaj kev tuag luv luv thiab ntev ntev hauv kev txhim kho lub tebchaws [2]. Qhov no yuav tsum muaj kev tshuaj xyuas niaj hnub los soj ntsuam kev kho mob hypothermia (kev cuam tshuam) piv rau normothermia (kev sib piv) hauv neonatal hypoxic encephalopathy (cov pej xeem), ntawm kev tuag thiab neurodevelopment (cov txiaj ntsig tau tshwm sim); thiab ib qho kev soj ntsuam cais hauv kev tsim lub teb chaws.
Nyem rau cistanche cov txiaj ntsig thiab kev mob tshwm sim rau lub hlwb
Txoj kev:
Peb tau tshawb nrhiav ntau lub databases yam tsis muaj hom lus lossis hnub txwv, rau kev sim ntsuas randomized (RCT) piv rau kev kho mob hypothermia (txhais tau tias yog lub cev tag nrho lossis xaiv lub taub hau txias, kom sov.<34.5° for 48-72hr) initiated within 6hr of birth, versus no hypothermia, in neonates with hypoxic encephalopathy (defined by Apgar scoring and/or cord blood analysis, and supporting clinical findings). We included RCTs reporting mortality before discharge, mortality at 18-24mo, mortality or neurologic disability at 18-24mo, disability at 18-24mo, and cerebral palsy at 18-24mo.
TSEEM CEEB:
Cov kev tshawb fawb, hloov kho rau 30 Lub Cuaj Hli 2021, txheeb xyuas 36345 cov ntawv sau. Kev tshuaj ntsuam xyuas cov npe, cov lus piav qhia, thiab cov ntawv sau tag nrho, los ntawm ob tus kws sau ntawv ntawm nws tus kheej, cov npe luv 149 cov ntawv sau tseg, ntawm 33 cov ntawv tshaj tawm, tshaj tawm 29 qhov kev sim, suav nrog. Siv cov cuab yeej Cochrane Risk of Bias 2 ob tus kws sau ntawv ntawm nws tus kheej categorized, 11, 8, thiab 10 RCT raws li muaj kev pheej hmoo siab, nruab nrab, thiab qis. Meta-analysis ua rau muaj kev pheej hmoo ntawm cov txheeb ze (nrog 95 feem pua CI). Kev tuag ua ntej tso tawm: 0.83 (0.71, 0.98), 23 kev sim, 2221 tus neeg koom, I2 37 feem pua (Daim duab 1). Kev tuag ntawm 18-24mo: 0.88 (0.78, 1.01), 11 kev sim, 2042 tus neeg koom, I2 51 feem pua (Daim duab 2). Kev tuag lossis kev tsis taus ntawm lub paj hlwb ntawm 18- 24mo: 0.79 (0.72, 0.86), 10 kev sim, 1917 tus neeg koom, I2 54 feem pua (Daim duab 3).
Neurological Disability ntawm {{0}}mo: 0.63 (0.53, 0.75), 10 kev sim, 1327 tus neeg koom, Kuv2 37 feem pua (Daim duab 4). Cerebral palsy ntawm 18-24mo: 0.63 (0.50, 0.78), 8 kev sim, 1136 tus neeg koom, I{{2 0}} feem pua . Cov ntaub ntawv no qhia txog cov txiaj ntsig tseem ceeb rau txhua qhov txiaj ntsig tshwj tsis yog kev tuag ntawm 18-24mos hnub nyoog. Kev tsom xam pab pawg neeg los ntawm qhov chaw kawm (tsim tawm piv rau cov teb chaws tsim) pom qhov sib txawv ntawm cov neeg tuag ua ntej tso tawm: RR 0.68 (0.51, 0.92), 8 kev sim, 79{ {45}} cov neeg koom, I{{30}} feem pua vim 0.92 (0.76, 1.11), 15 kev sim, 1431 tus neeg koom, Kuv2 48 feem pua ; thiab kev tuag ntawm 18-24mo: 0.79 (0.66, 0.93), 7 kev sim, 1212 tus neeg koom, I2 7 feem pua , piv rau 1.05 (0.86, 1.29), 4 kev sim, 830 tus neeg koom , kuv 2 65 feem pua . Lwm cov txiaj ntsig tau pom qhov txiaj ntsig ntawm TH hauv ob qho tib si tsim thiab tsim lub teb chaws; Qhov loj ntawm cov nyhuv yog ntau dua nyob rau hauv cov teb chaws tsim rau kev xiam oob khab thiab cerebral palsy.
CONCLUSION/IMPACT:
Cov ntaub ntawv no tau lees paub tias TH txo qis kev tsis taus neurologic thiab cerebral palsy tom qab menyuam mos hauv ntau qhov chaw. Txawm li cas los xij, cov txiaj ntsig xav tau ntawm cov neeg tuag nyob rau lub sijhawm luv thiab ntev yog qhov tsis paub tseeb hauv kev tsim lub tebchaws. Cov kev tshawb pom no yuav pab cov kws kho mob, tsev neeg, thiab cov neeg tsim txoj cai, ua pov thawj cov kev xaiv thiab kev txiav txim siab, hais txog kev kho mob hypothermia rau neonatal encephalopathy.
STudy ntawm Kev Kho Mob Cerebral Ischemia-reperfusion Injury nrog Cistanche Herba
Cistanche yog ib hom tshuaj suav tshuaj (TCM) uas tau siv ntau txhiab xyoo los kho ntau yam mob xws li impotence, infertility, thiab cem quav. Nws yog cov nroj tsuag cab uas loj hlob hauv thaj chaw arid thiab semi-arid ntawm Tuam Tshoj thiab Mongolia, thiab nws cov qia yog ib feem ntawm cov nroj tsuag uas yog siv rau kev kho mob.
Tsis ntev los no, tau muaj kev txaus siab rau kev siv cistanche rau kev kho mob cerebral ischemia-reperfusion raug mob (CIRI). CIRI yog ib qho mob uas tshwm sim thaum cov ntshav ntws mus rau lub hlwb raug cuam tshuam, ua raws li cov ntshav ntws rov qab los. Qhov no tuaj yeem ua rau oxidative stress, o, thiab cell tuag. CIRI yog ib qho tseem ceeb ntawm kev mob thiab kev tuag thoob ntiaj teb thiab yog ib qho kev txhawj xeeb tseem ceeb rau pej xeem kev noj qab haus huv.
Hauv tsab xov xwm no, peb yuav tshuaj xyuas cov kev tshawb fawb tam sim no ntawm cistanche hauv kev kho mob ntawm CIRI. Peb yuav tshawb nrhiav cov tshuaj pharmacological ntawm cistanche thiab cov txiaj ntsig kho mob ntawm cov tshuaj no.
Pharmacological mechanisms ntawm cistanche hauv kev kho mob ntawm CIRI
Cistanche muaj ntau lub tebchaw bioactive, suav nrog phenylethanoid glycosides, iridoids, thiab echinacoside. Cov tshuaj no yog lub luag haujlwm rau cov tshuaj pharmacological ntawm cistanche. Cov txheej txheem ntawm kev ua ntawm cistanche hauv kev kho mob ntawm CIRI yog txoj hauv kev thiab koom nrog ntau txoj hauv kev.
1. Cov teebmeem oxidative: CIRI induces oxidative stress nyob rau hauv lub hlwb, ua rau cov tsub zuj zuj ntawm reactive oxygen hom (ROS) thiab zus tau tej cov dawb radicals. Cistanche tau pom tias muaj zog antioxidant zog vim muaj phenylethanoid glycosides, uas tuaj yeem tshem tawm cov dawb radicals thiab tiv thaiv lipid peroxidation.
2. Anti-inflammatory teebmeem: CIRI kuj ua rau cov lus teb inflammatory hauv lub hlwb, uas exacerbates qhov kev puas tsuaj los ntawm oxidative kev nyuaj siab. Cistanche tau pom tias inhibit qhov kev qhia ntawm pro-inflammatory cytokines thiab inhibit qhov ua kom microglia thiab astrocytes, uas yog cov tseem ceeb players nyob rau hauv inflammatory teb.
3. Cov teebmeem ntawm Neuroprotective: CIRI ua rau kev tuag ntawm cov neurons, uas tuaj yeem ua rau muaj kev puas hlwb thiab kev puas hlwb. Cistanche tau pom tias muaj cov teebmeem neuroprotective los ntawm kev txo cov neuronal apoptosis thiab txhawb kev muaj sia nyob.
4. Kev txhim kho cerebral ntshav khiav: Cistanche tau pom tias txhim kho cov hlab ntsha hauv hlwb los ntawm dilating cov hlab ntsha thiab txo cov hlab ntsha.
Kev kho cov txiaj ntsig ntawm cistanche hauv kev kho mob ntawm CIRI
1. Cistanche tuaj yeem txo lub hlwb puas tsuaj los ntawm CIRI
Cov kev tshawb fawb tau pom tias cistanche tuaj yeem txo cov hlwb puas tsuaj los ntawm CIRI. Nyob rau hauv ib txoj kev tshawb fawb luam tawm nyob rau hauv phau ntawv Journal of Ethnopharmacology, cov kws tshawb fawb pom tias cistanche extract txo infarct ntim, txhim kho neurological muaj nuj nqi, thiab txo oxidative kev nyuaj siab nyob rau hauv nas raug CIRI.
Lwm txoj kev tshawb fawb luam tawm nyob rau hauv Suav Journal of Pathophysiology pom tias cistanche hmoov tuaj yeem txo cov ischemia-reperfusion raug mob hauv cov nas los ntawm nws cov tshuaj tiv thaiv antioxidant thiab tiv thaiv kab mob.
2. Cistanche tuaj yeem txhim kho kev txawj ntse
CIRI tuaj yeem ua rau muaj kev puas hlwb thiab kev nco tsis txaus. Txawm li cas los xij, cistanche tau pom los txhim kho kev txawj ntse hauv cov qauv tsiaj ntawm CIRI. Nyob rau hauv ib txoj kev tshawb fawb luam tawm nyob rau hauv Phau ntawv Journal of Neuroscience Research, cov kws tshawb fawb pom tias cistanche extract txhim kho kev kawm spatial thiab nco hauv nas raug rau CIRI.
3. Cistanche tuaj yeem txhawb nqa neurogenesis
CIRI kuj tseem tuaj yeem txo cov neurogenesis, uas yog cov txheej txheem tsim cov neurons tshiab. Txawm li cas los xij, cistanche tau pom los txhawb neurogenesis hauv tsiaj qauv ntawm CIRI. Hauv kev tshawb fawb luam tawm hauv Phau Ntawv Xov Xwm ntawm Suav Materia Medica, cov kws tshawb fawb pom tias cistanche extract nce tus naj npawb ntawm cov neurons tshiab hauv hippocampus ntawm nas raug rau CIRI.
4. Cistanche muaj ob peb yam kev mob tshwm sim
Ib qho ntawm qhov zoo ntawm cistanche yog tias nws muaj ob peb cov kev mob tshwm sim. Hauv kev tshawb fawb luam tawm hauv Phau Ntawv Xov Xwm ntawm Ethnopharmacology, cov kws tshawb fawb pom tias cistanche extract tsis ua rau muaj kev phiv loj hauv cov nas uas raug CIRI.
Cistanche tau pom cov lus cog tseg ua tus neeg sawv cev kho mob zoo rau kev kho mob ntawm CIRI. Nws cov tshuaj siv tshuaj, suav nrog tshuaj tua kab mob, tshuaj tiv thaiv kab mob, thiab cov teebmeem neuroprotective, ua rau nws muaj kev vam meej rau kev tiv thaiv thiab kev kho mob ntawm CIRI. Txawm li cas los xij, xav tau kev tshawb fawb ntxiv, tshwj xeeb hauv tib neeg kev sim tshuaj, txhawm rau tsim kom muaj kev nyab xeeb thiab ua tau zoo.
Cov ntaub ntawv
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