The Clinical Evaluation And FMRI(DWI,PWI) Study Of Human Urinary Kallidinogenase In Treatment Of Acute Cerebral Infarction

Background and Objective of the study:Acute cerebral infarction had high attack rate,mutilation rate ,recurrence rate and case fatality rate which gave great burden to the family and the society. At present, Evidence-Based Medicine showed that Stroke Unit, thrombolysis and antiplatelet drugs were effective methods in the treatment for the acute cerebral infarction, but the time window of thrombolysis therapy limited the Clinical use of thrombolysis. Human Urinary Kallidinogenase showed a relatively confirmative effect on the improvement of cerebral functions in patients with acute cerebral infarction by multiple ways such as enhancing angiogenesis around the ischemic boundary region and preventing the remote damage. Beside thrombolysis, it may be a new medication for acute cerebral infarction. While observing the efficacy,side-effects and the best treat time window of Human Urinary Kallidinogenase in treating patients with acute cerebral infarction, we also used DWI,PWI technique to observe the changes of ischemic area and the blood flow of the brain in treatment group and to evaluate the applied value of MRI in searching the functioning mechanism and accessing the therapeutic effect of neuron protectants.Method:The patients with acute cerebral infarction treated in Guangzhou First municipal People's Hospital from June 2007 to March 2009 were randomly divided into treatment group and control group. The patients in the control group were programmed to Salvia injection(produced by Harbin pharmaceutical group) therapy while the patients in experiment group were programmed to Human Urinary Kallidinogenase(produced by Techpool Bio-Pharma Co. Ltd) . The course of both groups were 14 days. We studied the improvement of the symptoms by analysing the NIHSS and mRS scores and observed the drug advers reactions. MRI scan (DWI,PWI)were performed in a part of patients before and after treated. Statistical Methods: SPSS 11.0 data analysis software, and measurement data with t-test, Counting information with X2 testing.Results:(1) General information: There were totally 91 cases meeting the criteria patients including, 60 cases of the experiment group and30 cases of the control group.There was no difference in the general situation such as age, gender, concomitant disease, time between onset and healing, NIHSS and mRS scores before healing. (P>0.05).(2) The NIHSS scores in the two groups were no statistical differences before treating, statistical differences emerged after treating between two groups.The improvement of NIHSS score in the experiment group was greater than the control group. And the adverse reaction rate in the two groups were no statistical differences.(3) 14 patients in experiment group performed DWI scan before and after treatment, and 7 patients in these 14 patients also performed PWI scan. MR imaging rusult showed that the brain ischemic area in the experiment group could be decreased after Human Urinary Kallidinogenase treated and there were statistical differences .DWI showed that the ADC value was improved in the edge of the ischemia and PWI showed that the CBF,CBV value were improved in the edge of the ischemia. All date have statistical differences(P<0.05)Conclusion:(1) Human Urinary Kallidinogenase showed a relatively conclusive effect on the improvement of cerebral functions in patients with acute cerebral infarction. The side-effects were minimal and easy to be controlled. (2) Human Urinary Kallidinogenase showed a best effect when used in 24 hour after acute cerebral infarction.(3) DWI and PWI could give the evaluation of therapeutic effect of Human Urinary Kallidinogenase in the cerebral infarction. We fould that Human Urinary Kallidinogenase had improved the blood flow in the cerebral infarction and the Cerebrovascular Reserve Capacity significantly. fMRI may have the application potential in monitoring the therapeutic effect and probing into the functioning mechanism of some neuron protectants.