尤瑞克林在组织型纤维蛋白酶原激活剂静脉溶栓治疗急性脑梗死中的应用

The application of urinary kallidinogenase in recombinant tissue plasminogen activator intravenous thrombolytic treatment in patients with acute cerebral infartion

目的初步评价尤瑞克林在重组组织型纤维蛋白酶原激活剂（rt-PA）静脉溶栓治疗急性缺血性脑梗死中的安全性和有效性。方法采用随机、对照研究方法，入选患者按1：1随机分为对照组和试验组。对照组22例，仅给予rt-PA（0．9mg／kg）；试验组22例，rt-PA（0．9mg／kg）溶栓后静脉滴注尤瑞克林（0．15 PNAu／d，连续7d）。主要安全性评价指标是溶栓24h内症状性脑出血发生率，次要评价指标为患者神经功能缺损评分（NIHSS）、日常生活活动能力评分（BI）。结果溶栓24h内，试验组与对照组比较，脑出血率差异无统计学意义（4．6％对9．1％，X^2=0．00，P〉0．05），再梗死率有降低趋势（18．2％对31．8％，X^2=1．091，P〉0．05）。溶栓治疗后1d、21d和90d，试验组NIHSS评分显著低于对照组（t值分别为2．119、2．913、2．187，均P〈0．05）；试验组90dBI评分显著高于对照组（t=2．39，P〈0．05）。结论在不增加出血风险的情况下，尤瑞克林提高rt-PA静脉溶栓治疗急性脑梗死的疗效。

Objective To evaluate the safety and efficacy of urinary kallidinogenase for recombinant tissue-type plasminogen activator （rt-PA） intravenous thrombolytic treatment in patients with acute cerebral infartion Methods A randomized control study was applied. All 44 patients with acute cerebral infartion were randomized 1 ： 1 to the experimental group （22 cases） and the control group （22 cases）. Patients were administrated rt-PA（0.9 mg/kg）in control group, and patients were given urinary kallidinogenase by intravenous drip （0.15 PNAU/d, for 7 days） after rt-PA intravenous thrombolytic treatment （0.9 mg/kg）in experimental group. The main evaluation index was the incidence of symptomatic intracerebral hemorrhage within 24 hours, and the secondary assessing items were NIHSS and BI. Results There was 1 case （4.6%） with symptomatic intracerebral hemorrhage in the experimental group and 2 （9.1%） in the control group （X^2 =0.00, P= 1. 000 ）, and reinfarction rate showed a decreasing tendency in experimental group （18. 2% vs. 31.8%, X^2 = 1. 091 ,P=0. 296 ）. Compared with the control group, the NIHSS scores were significantly lower 1, 21,90 days after thrombolytic therapy （t=2. 119, 2. 913, 2. 187; P=0. 041, 0. 006, 0. 042）,and the BI scores were obviously higher at 90 days after thrombolytic therapy in experimental group（t= 2.39, P= 0. 012 ）. Conclusions Without increasing the risk of intracerebral hemorrhage, urinary kallidinogenase may improve the curative effect for rt-PA intravenous thrombolytic treatment in patients with acute cerebral infartion