人尿激肽原酶对急性缺血性脑卒中患者的影响研究

Impact of Human Urinary Kallidinogenase on Patients with Acute Ischemic Stroke

目的探讨人尿激肽原酶(HUK)对急性缺血性脑卒中(AIS)患者的影响。方法选取2013年1月—2015年1月深圳市松岗人民医院神经内科收治的AIS患者60例,采用随机数字表法分为对照组与观察组,每组30例。在对症治疗基础上,对照组患者予以0.9%氯化钠注射液100ml,观察组患者予以HUK0.15PNAU+0.9%氯化钠注射液100ml;两组患者均连续治疗7d。比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数评分、区域软脑膜评分(rLMC)及治疗后改良Rankin量表(mRS)评分,观察治疗前后弥散加权成像(DWI)序列梗死体积、缺血半暗带(IP)体积、患侧/健侧相对灌注参数[相对平均通过时间(rMTT)、相对达峰时间(rTTP)、相对脑血容量(rCBV)、相对脑血流量(rCBF)]及侧支循环改善情况,计算ΔrMTT(治疗后rMTT-治疗前rMTT)、ΔrTTP(治疗后rTTP-治疗前rTTP)、ΔrCBV(治疗后rCBV-治疗前rCBV)、ΔrCBF(治疗后rCBF-治疗前rCBF)。结果治疗前两组患者NIHSS评分、Barthel指数评分、rLMC比较,差异无统计学意义(P>0.05);治疗后观察组患者NIHSS评分低于对照组,Barthel指数评分、rLMC高于对照组(P<0.05)。观察组患者治疗后mRS评分低于对照组(P<0.05)。治疗前两组患者DWI序列梗死体积、IP体积比较,差异无统计学意义(P>0.05);治疗后两组患者DWI序列梗死体积比较,差异无统计学意义(P>0.05),观察组患者IP体积小于对照组(P<0.05)。两组患者健侧ΔrMTT、ΔrTTP、ΔrCBV、ΔrCBF比较,差异有统计学意义(P<0.05);两组患者患侧ΔrMTT、ΔrTTP、ΔrCBF比较,差异有统计学意义(P<0.05);但两组患者患侧ΔrCBV比较,差异无统计学意义(P>0.05)。观察组患者侧支循环改善率高于对照组(P<0.05)。结论HUK能有效改善AIS患者神经功能,降低患者残障程度,提高患者日常生活能力,促进患者侧支循环建立。

Objective To investigate the impact of human urinary kallidinogenase on patients with acute ischemic stroke. Methods From January 2013 to January 2015, a total of 60 patients with acute ischemic stroke were selected in the Department of Neurology, the People＇s Hospital of Songgang, and they were divided into control group and observation group according to random number table, each of 30 cases. Based on symptomatic treatment, patients of control group received 0. 9% sodium chloride injection （ 100 ml ）, while patients of observation group received human urinary kallidinogenase （ 0. 15 ） combined with 0. 9% sodium chloride injection （ 100 ml） ; both groups continuously treated for 7 days. NIHSS score, Barthel index and regional leptomeninges score （rLMC） before and after treatment, modified Rankin scale （mRS） score after treatment were compared between the two groups; infarct volume under DWI sequence, ischemic penumbra volume, affected side/normal side relative perfusion parameters [ including relative mean transit time （rM＇IT）, relative time to peak （rTrP）, relative cerebral blood volume （rCBV） and relative cerebral blood flow （rCBF） ] and improvement of collateral circulation, while＇ △rMTT （ difference value of ArMrlT before and after treatment） , △rTTP （ difference value of △rTTP before and after treatment） , ArCBV （difference value of △rCBV before and after treatment ） and △rCBF （difference value of △rCBF before and after treatment） were calculated, Results No statistically significant differences of NIHSS score, Barthel index or rLMC was found between the two groups before treatment （P〉 0. 05）; after treatment, NIHSS score of observation group was statistically significantly lower than that of control group, Barthel index and rLMC of observation group were statistically significantly higherthan those of control group （P 〈 0. 05 ）. After treatment, mRS score of observation group was statistically significantly lower ＇than that of control group. No statistically significant differences of infarct volume under DWI sequence or ischemic penumbra volume was found between the two groups before treatment, nor was infarct volume under DWI sequence between the two groups after treatment （ P 〉 0. 05 ）, while ischemic penumbra volume of observation group was statistically significantly smaller than that of control group （P 〈0. 05）. There were statistically significant differences of normal side ArMq＇F, ArTFP, ArCBV and ArCBF between the two groups, so were affected side ArMTF, ArTrP and ArCBF （P 〈 0. 05 ）, while no statistically significant differences of affected side ArCBV was found between the two groups （ P 〉 0. 05 ）. Collateral circulation improvement rate of observation group was statistically significantly higher than that of control group （ P 〈 0.05 ）. Conclusion Human urinary kallidinogenase can effectively improve the neurological function, activity of daily living and collateral circulation of patients with acute ischemic stroke, reduce the degree of disability.