JAMA:陈会生教授团队发现远隔缺血适应能改善急性中度缺血性卒中患者功能预后(RICAMIS研究)

2022-08-17 辽宁省脑血管病创新联盟CDCIA 辽宁省脑血管病创新联盟CDCIA

这一来自中国本土的多中心研究成果登上世界顶级期刊,国际上首次为卒中神经保护治疗提供了强有力的证据,开启了急性缺血性卒中神经保护的新篇章。

2022年8月16日,一项由北部战区总医院神经内科主任、辽宁省脑血管病临床医学协同创新联盟(CDCIA)理事长陈会生教授牵头的多中心、随机对照研究(RICAMIS研究)在美国医学会杂志(JAMA)上发表。该研究评估了远隔缺血适应治疗对急性中度缺血性卒中患者功能预后的改善作用。研究结果显示,远隔缺血适应治疗组的90天内达到较好的神经功能预后患者比例显著高于对照组(67.4% vs 62.0%),在不良事件发生率方面,两组之间无显著性差异。这一来自中国本土的多中心研究成果登上世界顶级期刊,国际上首次为卒中神经保护治疗提供了强有力的证据,开启了急性缺血性卒中神经保护的新篇章。

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缺血性脑卒中现状:

据最新发布的《中国卒中报告2020》显示,2019年我国新发卒中394万例,因卒中死亡的人数高达219万人。目前,卒中已成为我国致死和致残的首要病因,对我国中年人特别是劳动力人群形成严重威胁,给国家和家庭造成极其沉重的社会及经济负担。

急性脑梗死目前有循证医学证据的治疗办法是恢复再灌注治疗(静脉溶栓、机械取栓治疗)、抗血小板和卒中单元。然而只有很少一部分人群能够在时间窗内进行恢复灌注治疗。

什么是远隔缺血适应治疗:

远隔缺血适应(Remote Ischemic Conditioning, RIC)是指通过对双上肢反复、适度的缺血训练后,诱导心、脑、肾等重要脏器对严重缺血、缺氧(如脑梗、脑供血不足、血管狭窄或闭塞)的保护,达到心脑血管病治疗和预防的作用。

RICAMIS研究简介:

该项多中心、开放标签、盲法评价的随机对照研究在中国的55家中心开展,总共纳入了1893急性缺血性卒中患者,并随机分成远隔缺血适应治疗组和对照组。结果显示,在主要结局方面,远隔缺血适应治疗组有582例(67.4%)患者在90天内达到了良好的神经功能预后(mRS 0-1分),对照组有566例(62.0%)患者在90天内达到了良好的神经功能预后(OR 1.2795% CI 1.05-1.54P = 0.02)。在不良事件方面,远隔缺血适应治疗组有59例患者出现了不良事件(6.8%),对照组有51例患者出现了不良事件(5.6%),两组无显著性差异。该研究表明:对于中度急性缺血性卒中患者,远隔缺血适应治疗可以有效地改善患者90天的神经功能结局。

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本文第一及通讯作者陈会生教授:

主任医师,医学博士,博士生导师,北部战区总医院神经内科主任,辽宁省脑血管病临床医学研究中心主任,辽宁省脑卒中质控中心主任。兼任辽宁省脑血管病临床协同创新联盟理事长,中华医学会神经病学分会委员及脑血管病学组委员,多个国际专业期刊审稿人。多个国内核心期刊杂志副主编及编委。擅长头面痛、脑卒中、静脉窦血栓、周围神经病的诊断与治疗。

主要研究方向:脑卒中的基础与临床研究。作为项目负责人,共获得国家科技部慢病专项子课题1项,国家卫健委脑防委多中心课题2项,国家自然科学基金5项,辽宁省科技攻关计划5项等;以第一或通讯作者在JACCJNNP等杂志上发表SCI论文70余篇。以第一承担人身份获得辽宁省自然科学二等奖1项,辽宁省医学科技奖二等奖1项。 

本研究的主体团队:

辽宁省脑血管病临床医学协同创新联盟(CDCIA

辽宁省CDCIA是辽宁省科技厅批准成立,依托辽宁省科协,由省内十四个中心城市100余家医院参与,形成了以脑血管病为靶目标疾病,将基础研究-临床研究-企业研发有机结合,以实现研发、临床研究、临床应用和技术推广的有效对接,于201735日成立。2018年成立了CDCIA科研团队,有30余家联盟医院参与组成。截至目前,已经成功开展了10余项联盟内多中心研究,各项研究开展顺利,均在clinicaltrial.com登记注册,多个研究方案发表在国际知名专业期刊。未来这些研究将助力我国脑血管病科研水平,提升辽宁省脑血管病科研的影响力和竞争力。联盟自成立以来,一直致力于提升我省各市县级等医疗机构的脑血管病规范化诊治水平,共举办省级会议13场,城市巡讲64场,短期规范化诊疗学习班32期,极大推动了我省脑血病的规范化诊治。

本研究联盟其他单位主要参与者:

北票市中心医院马宇彤主任、海城市中医院赵勇副院长、盘锦市中心医院韩敬主任、丹东市中心医院邓长青主任、中铁十九局医院洪梅主任、阜新市第二人民医院包颖主任、丹东市人民医院赵丽宏主任、朝阳市中心医院颜廷广主任、瓦房店第三医院邹仁林副院长、丹东966医院王辉主任、盘锦市中心医院李卓主任、丹东市第一医院万里姝主任、绥中县医院张力主任、辽阳县血栓病医院汪连强院长、抚顺市第二医院郭丽艳主任、桓仁满族自治县人民医院李明楠主任、盘锦市人民医院王冬青主任、抚顺市中心医院张强主任、苏家屯血栓病医院常大伟主任、台安县中医院张红莉主任、中国医科大学附属第一医院鞍山医院孙晶主任、辽阳县中心医院孟翀主任、岫岩县中心医院张再辉主任、铁岭县中心医院申丽颖副院长、沈阳医学院附属中心医院马莉主任、昌图县中心医院王桂春主任、沈阳市医学院附属中心医院李润辉主任、灯塔市中心医院张玲副院长、丹东市中心医院毕成主任、辽化总医院王莉云主任。

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    2022-11-11 whmdzju
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    2022-08-18 叶子12

    学习了,还需要进一步查查如何做这个缺血适应

    0

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    2022-08-17 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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    2022-08-17 病毒猎手

    厉害

    0