Studying the effect of different combinations of neuroprotectors on biochemical markers of inflammation, endothelial dysfunction and apoptosis in patients with ischemic stroke

Abstract

Background. Preservation and restoration of neurons in the ischemic penumbra by developing new methods for neuroprotection is one of the urgent issues of modern medicine. The purpose was to study the effect of different combinations of neuroprotectors with different mechanisms of action by analyzing markers of inflammation, endothelial dysfunction, and apoptosis in the blood serum of patients with ischemic stroke. Materials and methods. A randomized prospective controlled study was conducted on the use of neuroprotective complexes (NPC): NPC 1 (cerebrolysin + mexidol) and NPC 2 (cerebrolysin + citicoline), in patients with moderate and severe ische-mic stroke. They were randomly divided into groups: 1) comparison group — standard therapy; 2) NPC 1 along with standard treatment; 3) NPC 2 against the background of standard treatment. Laboratory studies on assessing interleukin-6, endothelin-1 and caspase-8 in blood serum were performed in dynamics, on days 1, 4 and 7. Results. In terms of anti-inflammatory activity, the therapy scheme, which included the administration of NPС 2, was 1.6–2.1 times (p < 0.01) ahead of standard treatment, as well as 1.2–1.4 times (p < 0.05) — of standard treatment combined with NPC 1. The regimen, which included NPC 2, in terms of endothelium protection and antiapoptotic effect exceeded standard treatment alone by 1.8–3.5 and 1.5–2.3 times (p < 0.01), respectively, as well as by 1.2–1.5 and 1.2–1.3 times (p < 0.05) — standard treatment combined with the use of NPС 1. Conclusions. The use of NPС 2 (cerebrolysin + citicoline) for the treatment of moderate and severe ischemic strokes in combination with standard therapy showed the most pronounced and reliable neuroprotective effect (p < 0.05).