Zhongguo cuzhong zazhi (Nov 2023)
人尿激肽原酶对大脑中动脉中重度狭窄所致急性缺血性卒中患者脑血管储备功能的影响 The Effect of Human Urinary Kininogenase on Cerebrovascular Reserve in Patients with Acute Ischemic Stroke due to Moderate to Severe Stenosis of the Middle Cerebral Artery
Abstract
目的 探讨人尿激肽原酶对大脑中动脉中重度狭窄所致急性缺血性卒中患者脑血管储备功能的影响。 方法 前瞻性纳入2020年1月—2021年12月在郑州人民医院神经内科住院的大脑中动脉中重度狭窄所致急性缺血性卒中患者。采用随机数字表法，将入组患者分为对照组和人尿激肽原酶组。对照组进行常规治疗；人尿激肽原酶组在对照组治疗基础上，给予静脉滴注人尿激肽原酶，每次0.15 PNA单位，溶于100 mL 0.9%氯化钠注射液，静脉滴注时间不少于50 min，持续10～14 d。治疗前及治疗后3个月，采用TCD检测大脑中动脉脑血管储备功能（cerebrovascular reserve，CVR）、屏气指数（breath-holding index，BHI），临床疗效评价采用NIHSS评分和mRS评分。 结果 共入组120例患者，平均年龄（63.0±6.5）岁，对照组和人尿激肽原酶组各60例。治疗前，两组的CVR和BHI差异无统计学意义；治疗后，与对照组相比，人尿激肽原酶组的CVR[（37.2%±4.1%）vs.（23.1%±3.2%），P＜0.001]和BHI[（1.64±0.40）vs.（1.14±0.34），P＜0.001]均显著增高。治疗前两组的NIHSS评分、mRS评分0～2分患者的比例差异无统计学意义；治疗3个月后，人尿激肽原酶组NIHSS评分低于对照组[4（3～5）分 vs. 5（3～6）分，P=0.022]，mRS评分0～2分患者的比例高于对照组[55.0% vs. 35.0%，P=0.028]。 结论 人尿激肽原酶注射液可改善大脑中动脉中重度狭窄所致急性缺血性卒中患者的CVR，并改善患者3个月的预后。 Abstract: Objective To investigate the effect of human urinary kininogenase on cerebrovascular reserve in patients with acute ischemic stroke caused by moderate to severe stenosis of the middle cerebral artery. Methods Patients with acute ischemic stroke caused by moderate to severe stenosis of the middle cerebral artery who were hospitalized in the Department of Neurology, People's Hospital of Zhengzhou from January 2020 to December 2021 were prospectively enrolled. The enrolled patients were divided into control group and human urinary kininogenase group by random number table method. The control group received conventional treatment. On the basis of the treatment of the control group, the human urinary kininogenase group was given intravenous infusion of human urinary kininogenase with 0.15 PNA units each time, dissolved in 100 mL of 0.9% sodium chloride injection, and the intravenous infusion time was not less than 50 min, lasting 10-14 days. Before treatment and 3 months after treatment, TCD was used to evaluate the cerebrovascular reserve (CVR) and breath-holding index (BHI) of the middle cerebral artery, respectively, and the clinical efficacy evaluation was carried out using NIHSS score and mRS score. Results 120 patients with an average age of (63.0±6.5) years were enrolled, including 60 cases in the control group and 60 cases in the human urinary kininogenase group. Before treatment, there were no statistically significant differences in CVR and BHI between the two groups. After treatment, compared with the control group, the CVR [(37.2%±4.1%) vs. (23.1%±3.2%), P<0.001] and BHI [(1.64±0.40) vs. (1.14±0.34), P<0.001] in the human urinary kininogenase group were significantly increased. There was no significant difference in the proportion of patients with NIHSS score and mRS score of 0-2 between the two groups before treatment. Three months after treatment, the NIHSS score of the human urinary kininogenase group was lower than that of the control group [4 (3-5) points vs. 5 (3-6) points, P=0.022]. The proportion of mRS score of 0-2 points of the human urinary kininogenase group was higher than that of the control group [55% vs. 35%, P=0.028]. Conclusions Human urinary kininogenase injection can improve the CVR of patients with acute ischemic stroke caused by moderate to severe stenosis of the middle cerebral artery, and can improve the prognosis of patients at 3 months.
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