应用磁共振技术观察人尿激肽原酶对急性脑梗死患者脑血流灌注的影响

Effect of human urinary kallidinogenase on brain perfusion observed by magnetic resonance technology in patients with acute cerebral infarction

目的应用磁共振技术观察人尿激肽原酶（尤瑞克林）对急性脑梗死患者脑梗死灶大小、脑血流等的影响，进一步阐明药物的可能作用机制。方法选取发病48h内的急性脑梗死患者41例，随机分为尤瑞克林组（23例）和丹参组（18例）。根据美国国立卫生院卒中量表（NIHSS），将患者分成轻、中、重三度。尤瑞克林组，给予0．15PNA单位尤瑞克林，丹参组给予400mg丹参，均为静脉滴注．1次／d，10d为一疗程。于治疗前及治疗后10d对患者进行头部磁共振多序列的检查。发病后30、90d采用改良Rankin量表评定患者的临床预后。结果①两组治疗后NIHSS分值，均较治疗前降低（P〈0．01）；NIHSS〉10的中、重度患者，尤瑞克林组、丹参组治疗前后NIHSS差值中位数分别为4．0（3．0～7．0），2．0（2．0～3．0），差异有统计学意义（P=0．037），尤瑞克林组对中、重度患者疗效更好；②尤瑞克林组、丹参组梗死灶增大的比率分别为42．9％（9／21）和41．2％（7／17）．差异无统计学意义（P=0．92），两组梗死灶渗血率分别为38．1％（8／21）和11．8％（2／17），差异无统计学意义（P=0．14）；③尤瑞克林组及丹参组在治疗后，梗死区局部脑血流量均较治疗前增加，差异有统计学意义（P〈0．001）；尤瑞克林组在治疗后相对局部脑血流星（梗死区脑血容量／镜像区脑血容量）增加较丹参组明显，分别为1．26±0．13和1．05±0．26，差异有统计学意义（t=2．18，P〈0．05）；④MRA显示两组患者的大血管再通比例分别为5／7和3／6，差异无统计学意义（P=0．59）。结论尤瑞克林能增加急性脑梗死患者的梗死区血液供应；与丹参组比较对中、重度患者疗效更好。

Objectives To observe the effect of human urinary, kallidinogenase on the size of cerebral infarction and the cerebral blood flow by using magnetic resonance technology and to elucidate the possible mechanism of the agent. Methods A total of 41 patients with acute cerebral infarction within 48 hours of onset were enrolled and were randomized into urinary kallidinogenase group（ n = 23 ） and Danshen group （n = 18）. The patients were divided into mild, moderate and severe cerebral infarction according to the National Institute of Heahh Stroke Scale （NIHSS）. The urinary kallidinogenase group received urinary, kallidinogenase 0.15 PNA unit, and the Danshen group received Danshen 400 rag, both agents were intravenously infused, once a day, 10 days as a course. All patients were observed with MRI （ including T1WI, T2WI, T2FLAIR, MRA, DWI and PWI sequences） before and 10 days after the treatment. The clinical prognosis of the patients was assessed with the modified Rankin scale at 30 and 90 days after the onset of symptoms. Results ①The NIHSS scores in both groups after the treatment were lower than those before the treatment （P 〈0.01 ）. In patients with moderate and severe cerebral infarction whose NIHSS was 〉 10, their NIHSS median difference scores were 4.0 （ 3.0 - 7.0） and 2.0 （2.0 - 3.0） respectively before and after the treatment in the urinary kallidinogenase and Danshen groups, and there were significant differences （P = 0. 037）. The efficacy was better in patients with severe cerebral infarction in the urinary kallidinogenase group. ②The ratio of increased volume of cerebral infarction were 42.9% （9/21） and 41.2% （7/17） respectively in the urinary kallidinogenase and Danshen groups, and there was also no significant difference （χ^2 = 0.01, P = 0.92）; the rate of plasma exudation were 38. 1% （8/21） and 11.8% （2/17） respectively in both groups, and there was also no significant difference （P = 0. 14）. ③Regional cerebral blood flow （rCBF） in the infarcted area after the treatment in the urinary kallidinogenase and Danshen groups were increased as compared with that before treatment, and there was significant difference （P 〈 0. 001 ）. The relative rCBF （cerebral blood volume in the infarcted area/cerebral blood volume in the mirror image area） after the treatment in the urinary kallidinogenase group was increased remarkably as compared with that after the treatment in the Danshen group （1.26 ±0.13 and 1.05 ± 0.26, respectively）, and there was significant difference （t = 2.18 ,P 〈 0.05 ）. ④The recanalization rate in the patients of both groups were 71.4% and 50.0% respectively, and there was no significant difference（P = 0.59）. Conclusion Urinary kallidinogenase may increase regional blood supply in infarcted areas in patients with acute cerebral infarction and effectively improve the neurological deficit of patients. It efficacy is more remarkable in the urinary kallidinogenase group than that in the Danshen group in patients with moderate and severe cerebral infarction.