Citicoline is an intermediate product of phosphatidylcholine biosynthesis. After cerebral ischemia, citicoline increases the stability of cell membranes, increases glutathione levels, and inhibits phospholipid hydrolysis and arachidonic acid production. , thereby limiting the generation of oxygen free radicals and lipid peroxides. At the same time, the drug can also increase cerebral blood flow, promote brain energy metabolism, and improve cerebral circulation, thus playing a neuroprotective role. The drug has positive effects on a variety of central nervous system injury models, neurodegenerative diseases, facial neuritis, sudden deafness, hyperemesis gravidarum, and young amblyopia. This drug is reviewed below.
1. Traumatic brain injury
1.1 Preventing acute brain swelling during craniotomy for severe craniocerebral injury
When acute brain compression occurs, intracranial pressure rises or the hypothalamus is directly damaged, the cerebrovascular tension drops rapidly, eventually leading to cerebrovascular paralysis and sudden expansion of the cerebrovascular bed, clinically manifested as acute brain swelling. In order to explore the clinical efficacy of high-dose citicoline in preventing acute brain swelling during craniotomy for severe craniocerebral injury, Xiao Sui observed 36 cases of severe craniocerebral injury at the beginning of the craniotomy, that is, when incising the scalp, a large dose Add 1000 mg of citicoline to 250 ml of mannitol for intravenous infusion, and finish the infusion within 0.5 h. Results Except for 6 patients with severe bilateral brain contusion and laceration who developed brain swelling and encephalocele during the operation, the rest did not suffer from brain swelling or encephalocele. This shows that large-dose cytotoxicity is used at the beginning of craniotomy for severe craniocerebral injury. Phosphocholine has a good effect on preventing brain swelling and encephalocele, ensuring the smooth progress of the operation and reducing secondary damage to brain tissue.
1.2 Treatment of prolonged coma after traumatic brain injury
When a patient with a traumatic brain injury has not recovered consciousness 4 weeks after coma, it is called a prolonged coma. It is a common consequence of patients with severe craniocerebral injury. Although these patients do not die in the acute phase, they have a negative impact on their families and society due to poor recovery. Come with a heavy burden. In order to explore the clinical efficacy of carotid artery injection and intravenous infusion of citicoline in the treatment of prolonged coma due to brain trauma, Dai Jianming et al. used carotid artery injection of citicoline in 30 patients with prolonged coma, and the other 30 cases received conventional intravenous infusion. Citicoline, 14 days constituted a course of treatment, and the two groups were supplemented with the same conventional treatment. The results showed that the efficacy of carotid artery injection of citicoline was significantly higher than that of intravenous infusion group (P<0.05), indicating that the efficacy of carotid artery injection of citicoline in the treatment of prolonged coma caused by brain trauma was significantly higher than that of intravenous infusion.
1.3 Acute traumatic brain injury
Wang Yi et al. randomly divided 80 elderly patients with mild acute traumatic brain injury (TBI) into two groups. The control group was given 10 mg nicergoline tablets, 3 times/d; Phosphocholine 0.2 g, 3 times/d. The treatment course for both groups was 4 weeks. Electroencephalogram (EEG) and transcranial Doppler ultrasound (TCD) were reviewed after 4 weeks and 3 months of treatment respectively. Results The total clinical effective rates of the treatment group and the control group were 95.0% and 87.5% respectively (P<0.05); the improvement of cranial Doppler ultrasound and electroencephalogram was better than that of the control group (P<0.01) . It is suggested that Citicoline Capsules can protect neuronal cells and improve the clinical efficacy of elderly patients with mild acute TBI.
2. Stroke
2.1 Acute cerebral infarction
Acute cerebral infarction is mainly caused by atherosclerosis in the brain that narrows and occludes blood vessels, thereby forming thrombus, resulting in local ischemia and hypoxia. The key to early treatment is to restore the blood supply to the infarct area, rescue brain cells in the ischemic penumbra area, and restore the function of surviving nerve cells in the penumbra area. Citicoline can change the physiological function of the meninges, improve cerebrovascular tension, increase cerebral blood flow and oxygen consumption, promote awareness, and improve hemiplegia symptoms.
In order to explore the clinical effect of vinpocetine combined with citicoline in the treatment of acute cerebral infarction, Duan Yanpei randomly divided 80 patients with acute cerebral infarction into two groups, and 40 patients in the control group were given Compound Danshen Injection and Naofukang Injection. , intravenous infusion once/d; 40 patients in the treatment group were given vinpocetine and citicoline injection, intravenous infusion once/d, and the treatment course of both groups was 14 days. The efficacy is judged by changes in neurological deficit scores, and the improvement of neurological function and adverse reactions after treatment are observed. Results: The effective rate of the treatment group was 92.5%, and the effective rate of the control group was 72.5%. The therapeutic effect of the treatment group was significantly better than that of the control group, and the difference between the two groups was statistically significant (P<0.01).
2.2 Acute cerebral hemorrhage
Research has confirmed that citicoline treatment can reduce secondary damage caused by cerebral hemorrhage, reduce cerebral edema, and improve the prognosis of neurological function. In order to evaluate the efficacy and safety of Citicoline Sodium Tablets in the treatment of acute cerebral hemorrhage, Zhou Muke adopted a randomized, double-blind, double-simulation, positive drug parallel control clinical trial method, and randomly divided patients who met the selection criteria into two groups: The 18 patients in the test group were given oral administration of citicoline sodium tablets 0.2 g/time, 3 times/d; citicoline sodium simulation capsules 0.2 g/time, 3 times/d. The 18 patients in the control group were orally administered citicoline sodium capsules 0.2 g/time, 3 times/d; Citicoline sodium analog tablets 2 g, 3 times/d. The treatment courses are all 21 days. The National Institutes of Health Stroke Scale (NIHSSS) and Barthel Poloxamer 188 Index (BI) were used to evaluate neurological recovery. Results The NIHSS scale scores and Barthel index of the two groups of subjects after treatment were significantly improved compared with before treatment (P0.05). It shows that Citicoline Sodium Tablets are effective and safe in treating neurological deficits caused by acute cerebral hemorrhage. Compared with Citicoline Sodium Capsules, the efficacy of the two dosage forms isIt is related to the function of the spinal cord vomiting center and chemoreceptor trigger zone nerve cells. Guo Cunling discussed the efficacy of citicoline combined with vitamin B6 in the treatment of hyperemesis gravidarum. 60 patients with hyperemesis gravidarum were randomly divided into two groups. The control group was given routine fluid replenishment, electrolyte supplementation, amino acid supplementation, correction of acid-base balance disorders, and vitamin B6 treatment; The observation group was given intravenous drip of 500 mg of Citicoline Injection on the basis of the control group. Results: The effective rate of the observation group was 96.7%, and that of the control group was 73.3%. The efficacy of the observation group was significantly higher than that of the control group (P<0.05). There were no obvious adverse reactions in both groups, indicating that citicoline combined with vitamins B6 is definitely effective in treating hyperemesis gravidarum.
4.3 Early curative effect on amblyopia at young ages
Citicoline is an endogenous molecule, a specific intermediary for the synthesis of phosphatidylcholine and a cell membrane structural phospholipid. It can adjust the conversion rate of catecholamines and 5-hydroxytryptamine, especially in the substantia nigra and striatum. Stimulates dopamine metabolism in the body’s dopamine system, thereby increasing the levels of norepinephrine and dopamine in the central nervous system. Many aspects of vision are affected by dopamine, including vision, contrast sensitivity, etc. In addition, citicoline can restore the activity of mitochondrial ATPase and Na/K-ATPase, and inhibit the activity of phospholipase A2. By reducing the response threshold of the visual system, synaptic connections that were originally unactivated are activated to restore their functions, thereby improving visual function.
Wang Huanyan was to observe the early clinical efficacy of Citicoline Sodium Tablets combined with physical therapy in the treatment of young children with amblyopia. 80 children with amblyopia aged 3 to 6 years old who met the research requirements were randomly divided into a physical therapy group that received physical therapy and a drug combination therapy group that took Citicoline Sodium Tablets in conjunction with physical therapy based on the principle of consistent amblyopia degree and type. , take citicoline sodium tablets 0.2 g/time, 2 tablets/d. The treatment course for both groups was 3 months. Results: The effective rate and basic cure rate of the combined drug treatment group were better than those of the physical therapy group (P<0.05), indicating that early administration of Citicoline Sodium Tablets can effectively enhance the efficacy of physical therapy for young children with amblyopia and help To shorten the course of treatment.
4.4 Sudden deafness
It is currently believed that the main cause of sudden deafness is blood circulation disorder in the inner ear. Vasospasm, edema, hemorrhage, and red blood cell agglutination caused by any reason, resulting in insufficient blood supply to the inner ear, can cause tissue hypoxia and metabolic disorders, causing the inner ear terminals to Receptors are damaged. Citicoline sodium contains neurotrophic substances that promote the recovery of neurological function, stimulates the growth of sympathetic nerve cells, promotes the repair of nerve cells, reduces cerebral vascular resistance, increases cerebral blood flow, and increases blood supply to lesions.
In order to explore the clinical efficacy of vinpocetine combined with citicoline sodium in the treatment of sudden deafness, Liu Liqin randomly divided 64 patients into a treatment group (36 ears) and a control group (40 ears) with 32 cases each. The group started with intravenous infusion of vinpocetine, once a day; intravenous infusion of 0.5 g of citicoline sodium, with a course of 7 to 10 days. After a 3-day rest, the treatment could be repeated. In the control group, 60 mg of adenosine triphosphate, 100 U of coenzyme A, 30 mg of cytochrome C and 0.5 g of citicoline were dissolved in 500 ml of 10% glucose injection for intravenous infusion, 1 7~/d; compound recipe Salvia miltiorrhiza injection 250ml is intravenously dripped once a day, and a course of treatment is 7 to 10 days. The results showed that the effective rate of the treatment group was 86.11% and that of the control group was 70.00% (P<0.05), indicating that the combined application of vinpocetine and citicoline sodium has good clinical efficacy in the treatment of sudden deafness.
In short, as a neuroprotective agent, citicoline can quickly repair damaged neuronal cell membranes, increase cerebral blood flow, promote the brain’s energy metabolism, improve cerebral circulation, and is useful in the treatment of brain trauma, stroke and other brain diseases. It is effective for neurological diseases. It also shows positive therapeutic effects in the treatment of facial neuritis, sudden deafness, hyperemesis gravidarum, young amblyopia and other diseases.
