联合MRS及CTP观察尤瑞克林治疗大面积脑梗死的疗效研究

The combination of MRS and CTP to observe the effect of human urinary Kallikrein in the treatment of massive cerebral infarction

目的联合磁共振波谱(Magnetic Resonance Spectrum,MRS)分析及CT灌注成像(CT perfusion imaging,CTP)观察尤瑞克林对大面积脑梗死患者的临床疗效。方法将62例大面积脑梗死患者,随机分为尤瑞克林治疗组(试验组)和常规治疗组(对照组)各31例;两组患者均给予常规内科处理(包括合并高血压、糖尿病、心脏病等的一般药物治疗),试验组在常规治疗的基础上加用尤瑞克林治疗。采用NIHSS评分评价治疗前及治疗后14 d患者神经功能缺损变化。采用Barthel指数记分法评定日常生活活动能力(ADL)记录患者治疗前及治疗后14 d、30 d、90 d的评分。用MRS分析患者治疗前及治疗后14 d脑梗死组织代谢物N-乙酰天门冬氨酸(NAcetylpartate,NAA)、胆碱(Choline,Cho)、肌酸(Creatine,Cr)及乳酸(Lactate,Lac)的含量。用CTP分析治疗前及治疗后14 d梗死区rCBF、rCBV、rTTP和rMTT指标。结果治疗前两组患者NIHSS评分、Barthel指数、hs-CRP水平、MRS及CTR的各检测指标的差异无显著性意义(P>0.05);治疗后,发现各组患者上述指标均较治疗前明显改善(P<0.05);但尤瑞克林组的改善幅度尤为显著,两组间差异均具有显著性意义(P<0.05)。结论尤瑞克林可明显改善大面积脑梗死患者的神经功能缺损和日常生活能力,作用机制可能是通过改善梗死区的微循环和神经细胞的代谢。

Objective To investigate the efficacy of Human Urinary Kallikrein in the treatment of massive cerebral infarction（MCI） combination of MRS and CTP.Methods 62 patients with MCI were randomly divided into the groups treatment and control.All the patients were given a basic therapy.Human Urinary Kallikrein was administrated to the patients in the treatment group for14 days in addition to the basic therapy.All the patients have been evaluated by NIHSS and BI before treatment and at days 14,30 and 90 d afterthe treatment.MRS analyzed the contents of metabolites N-acetyl aspartate（NAA）,choline（Cho）,creatine（Cr）,and Lactate（Lac） in patients with cerebral infarction before and aftertreatment.rCBF,rCBV,rTTP and rMTT indexes in infarct area before and 14 d aftertreatment were analyzed by CTP.Results No changes were shown ragarding NIHSS,BI,hs-CRP,MRS and CTP before treatment in both groups（P〉0.05）.There were significantly difference regarding those between the both groups aftertreatment（P〈0.05）,especially in treatment group.Compared with that before treatment,NIHSS and BI was improved 14 d,30 d,90 d aftertreatment in treatment group,there was significantly difference between both groups（P〈0.05）.Conclusion Human Urinary Kallikrein can obviously improve the degree of nerve function defect in patients with cerebral infarction and the ability of daily life,the mechanism is probably through the improvement of the infarcted area of the microcirculation and metabolism of nerve cells.