Human urinary kallidinogenase for acute ischemic stroke: a retrospective case series study
10.3760/cma.j.issn.1673-4165.2019.05.006
- VernacularTitle:人尿激肽原酶治疗急性缺血性卒中:回顾性病例系列研究
- Author:
Yan WANG
1
;
Xiangyang ZHU
;
Dongmei ZHANG
;
Tianle WANG
;
Li ZHU
Author Information
1. 南通大学第二附属医院神经内科 226001
- Keywords:
Stroke;
Brain ischemia;
Kallikreins;
Inflammation;
C-Reactive protein;
Magnetic resonance imaging;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2019;27(5):348-354
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of human urinary kallidinogenase (HUK) on cerebral perfusion,inflammatory marker level,neurological deficits,and short-term clinical outcomes in patients with acute ischemic stroke who exceeded the time window of thrombolytic therapy.Methods Patients with acute ischemic stroke exceeded the time window of thrombolytic therapy and treated in the Department of Neurology,the Second Affiliated Hospital of Nantong University from June 2016 to March 2018,and performed magnetic resonance perfusion imaging on the 1st and 14th d after admission were enrolled retrospectively.Patients were divided into HUK and control groups according to whether they received HUK treatment or not.All patients underwent magnetic resonance perfusion imaging and serum inflammatory markers measurement on the 1st and 14th d after admission.The National Institute of Health Stroke Scale (NIHSS) scores,cerebral perfusion levels,and serum inflammatory marker levels were compared between the 2 groups.On the 14thd after admission,the outcome was determined according to the modifiel Rankin Scale (mRS) scores.0-2 was defined as good outcome and ＞2 was defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of outcome.Results A total of 62 patients with acute ischemic stroke exceeded the time window of thrombolytic therapy were enrolled,including 37 patients in the HUK group and 25 in the control group.There were no significant differences in the demographic and other baseline data between the HUK group and the control group,except for baseline NIHSS score (P =0.049).The reduction of NIHSS score after treatment in the HUK group was more significant than that in the control group (P ＜0.01).Serum high-sensitivity C-reactive protein level in the HUK group decreased significantly after treatment (P ＜ 0.01),and plasma lipoprotein-associated phospholipase A2 also showed a downward trend.In terms of perfusion imaging parameters,the relative cerebral blood flow was significantly increased after treatment in the HUK group,and the relative mean transit time and relative peak time were significantly decreased.The above increase and decrease were statistically significant compared with the control group (all P＜0.05).On the 14th d after admission,the mRS score showed that 51 patients had a good outcome and 11 had a poor outcome.Multivariate logistic regression analysis showed baseline NIHSS scores (odd ratio [OR] 2.545,95％ confilence interval [CI]1.124-5.541;P=0.024),atrial fibrillation (OR 5.712,95％ CI 1.737-24.685;P=0.039),and cardiogenic embolism (OR 4.485,95％ CI 1.148-18.262;P =0.040) were the independent risk factors for poor outcomes,and whether using HUK was not significantly associated with the outcomes.Conclusion For patients with acute ischemic stroke that exceeds the time window for thrombolysis,HUK improves cerebral perfusion,reduces inflammation,and improves neurological deficits in patients,but does not improve short-term neurological outcomes.
