| Objective To use 320-slice multimode CT and transcranial doppler (TCD) combined with breath-holding test for clinical research of the therapeutic value and security of human urinary kallidinogenase on the patients in acute stage of cerebral ischemic stroke,and to build a related drug evaluation process. Method A total of 39 patients of acute anterior circulation cerebral ischemic stroke within 48 hours of onset whose scores were between 4 to 20 according to the National Institute of Health Stroke Scale (NIHSS) were enrolled .The patients were divided into human urinary kallidinogenase group (HUK group,n=21) and control group (n=18) with the forward-looking, no randomized controlled, open research methods. The two groups received human urinary kallidinogenase 0.15 PNA unit or Xueshuantong 300mg, both agents were intravenously, once a day, 10 days as a course . All patients were observed with 320-slice multimode CT and transcranial doppler (TCD) combined with breathing-holding test before and 10 days after the treatment to evaluate of the core of the infracted area relative regional cerebral blood volume (rrCBV)(rCBV in the target area of the suffering side/rCBV in the mirror image area of the opposite side),relative regional cerebral blood flow (rrCBF)(rCBF in the target area of the suffering side/rCBF in the mirror image area of the opposite side),relative mean transit time (rMTT)(rMTT in the target area of the suffering side/rMTT in the mirror image area of the opposite side),relative time to peak (rTTP)(rTTP in the target area of the suffering side/rTTP in the mirror image area of the opposite side). Meanwhile , modified vascular TICI grading standards was used to evaluate responsibility vascular before and after the treatment .Besides,to use Germany DWL Transcranial doppler ultrasound blood analyzer Multi-DopX to measure the average blood flow velocity (Vm) of responsibility vascular and the corresponding ones in the opposite side before and after breathing-holding test and to calculate the rBHI (BHI of the criminal vascular/BHI of the corresponding ones in the opposite side ). What's more, their NIHSS were scaled and recorded before the treatment , NIHSS ,mRS and BI 10 days after the treatment , mRS and BI after 90±5 days after the treatment . Result (1) There was no significant difference in age, sex, risk factors and Baseline NIHSS scores. It is comparable (P >0.05) . (2) Relative regional cerebral blood volume (rrCBV) ,relative regional cerebral blood flow (rrCBF),relative mean transit time (rMTT),relative time to peak (rTTP),rBHI in the infracted area after the treatment in the urinary kallidinogenase group and control group were improved as compared with that before treatment , and there was significant difference (P<0.05). (3) The relative rCBV ( regional cerebral blood volume ) after the treatment in the urinary kallidinogenase group was increased as compared with that after the treatment in the control group and there is significant difference ( t=2.36,P=0.046<0.05 ) ; rrCBF after the treatment in the urinary kallidinogenase group was increased as compared with that after treated in the control group and there is significant difference ( t=2.78,P=0.02<0.05 ) ; relative time to peak (rTTP) after treated in the urinary kallidinogenase group was decreased as compared with that after treated in the control group and there is significant difference ( t=2.67,P=0.03<0.05 ) ; relative mean transit time (rMTT) after treated in the urinary kallidinogenase group was decreased as compared with that after treated in the control group but there is no significant difference ( t=0.06,P=0.95>0.05 ) . rBHI after the treatment in the urinary kallidinogenase group was increased as compared with that after treated in the control group and there is significant difference .(4) The ratio of responsibility vascular (series increase) in the two groups is 4/21 and 3/18 respectively, P=1.0>0.05 and there is no significant difference. (5) Their recorded NIHSS ,mRS and BI. were improved after treated as compared with those before treatment and there is significant difference (P<0.05 ); (6) The recorded NIHSS after treated in the urinary kallidinogenase group was decreased as compared with that after treated in the control group and the recorded BI after treated in the urinary kallidinogenase group was increased as compared with that after treated in the control group and there is significant difference (P<0.05 ) , there is no significant difference (P<0.05 ) in the decrease of their mRS after treated .Conclusion (1)Human Urinary kallidinogenage may increase regional blood perfusion in the core of the infraction areas , improve cerebrovascular reserve capacity, stimulative nerve functional recovery, with good safety. (2)Human Urinary kallidinogenase should be used in 24 hours to get a better curative effect and a better prognosis. (3)There is great application value in the drug evaluation of cerebral ischemic by 320-slice multimode CT and TCD combined with breath-holding test. |
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