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氢气治疗噪声耳聋药物治疗研究进展
南伊利诺大学医学院CoralTieu和KathleenCCampbell最近在耳鼻喉科学Otolaryngology杂志上发表一篇综述，系统总结了噪声性耳聋药物治疗研究的进展。
通过了解噪音性听力损失（NIHL）的基本机制，人们正在开发几个有前途的耳保护药物。相反，这些保护性药物的实验结果与也有助于进一步阐明噪声性听力损失的机制。本文回顾了针对NIHL的耳保护药物的基础研究论文、临床试验已经正在计划中的临床试验。预防和治疗药物包括抗氧化剂、血管扩张剂、糖皮质激素和凋亡通路抑制剂等。关于抗氧化剂，发挥作用的具体机制不同，主要包括D-蛋氨酸、N-乙酰半胱氨酸、依布硒、维生素A、维生素C、维生素E、镁离子ACE、复合维生素矿物质、辅酶Q10、氢气分子、镁离子和地塞米松等。文章对这些药物的优点、缺点、研究进展进行了简要描述。药物安全性和有效性同样重要，针对具体患者都需要认真对待。尽管目前没有任何一种噪声性听力损失的治疗药物被PDA批准，但不久的将来，有希望有部分药物可以被批准用于临床。另外，通过对噪声性听力损失病理生理学机制的理解，人们可以发展出理想的治疗药物。
文章中关于氢气的描述，并没有全面总结这方面的进展，至少关于氢气治疗噪声耳聋有3篇论文发表，但作者只针对其中一篇进行了分析，显然是不全面的。
Linetal.showedprotectionagainstTTSandacceleratedrecovery
ofdistortionproductotoacousticemissions(DPOAEs),ameasureof
outerhaircellfunction,usingmolecularhydrogen[11].Molecular
hydrogenisaknowntherapeuticandpreventiveantioxidantthat
selectivelyreducesthehydroxylradical,themostcytotoxicoftheROS
[79].Totestitsotoprotectiveabilities,guineapigsreceivedeitherplain
waterorhydrogen-richwaterfor14dayspriortonoiseexposure.
TheanimalsthenreceiveddBSPL4kHzoctavebandnoisefor3
hours.Allanimalsunderwentauditorybrainstemresponse(ABR)and
DPOAEtestingbeforetreatmentandthenimmediately,1,3,7and14
dayspostnoiseexposure.Comparedtoplainwatercontrols,theABR
thresholdsat2and4kHzweresignificantlybetterinthehydrogensupplemented
animalsonpost-noisedays1,3and14.Thehydrogentreated
animalsalsoshowedgreateramplitudeofDPOAEinput/
outputgrowthfunctionsduringrecoverywithstatisticalsignificance
onpost-noisedays3and7.Thisstudyfurthersupportstheantioxidant
theoryofotoprotectionandsuggeststhathydrogencanfacilitatehair
cellrecoveryfollowingnoiseexposureandattenuateTTS.
CurrentPharmacologicOtoprotectiveAgentsinorApproachingClinicalTrials:HowTheyElucidateMechanismsofNoise-InducedHearingLoss
Throughunderstandingtheunderlyingmechanismsofnoise-inducedhearingloss(NIHL),severalpromisingpharmacologicotoprotectiveagentsareindevelopment.Conversely,theexperimentalresultswiththeseprotectiveagentsfurtherelucidateNIHLmechanisms.ThisarticlereviewsthemajorclassesofotoprotectiveagentsforNIHLthathaveundergonepublishedpeerreviewedclinicaltrials,orarecurrentlyinorapproachingFDAapprovedclinicaltrials.Bothprophylacticandrescueagentsareincluded.Theclassesofagentsincludeantioxidants,vasodilators,andglucocorticoids.Apoptoticpathwayinhibitorsarebrieflymentioned.Forantioxidants,someofthedifferencesintheexactantioxidantmechanismsareincluded.ProtectiveagentsreviewedincludeD-methionine,N-acetylcysteine,ebselen,ACEMg,Acuval,CoQ10,molecularhydrogen,magnesiumasasingleagent,anddexamethasone.Theadvantages,disadvantages,andstateofdevelopmentareincludedforeachagent.Bothsafetyandefficacyareconsideredasareconsiderationsforspecificpatientpopulationsifknown.Further,resultsofanimalandclinicaltrialsarebrieflydescribedfromthepublishedliterature.AlthoughnopharmacologicagentisyetapprovedbytheFDAforclinicalusetopreventortreatnoiseinducedhearinglossatthistime,itishopedthatwithinthenextdecadeandperhapswithinthenextfewyearsoneormoreagentswillbeavailableforclinicaluse.Furtheritishopedthatthroughanunderstandingoftheunderlyingmechanismsandnoise-inducedhearinglossandotoprotection,evenmoresafeandeffectivepharmacologicotoprotectiveagentswillbedeveloped.
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