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目的:探讨人尿激肽原酶(HUK)对急性脑梗死患者侧支循环与脑血流灌注的影响,以找寻新的药物来有效开放侧支循环,挽救缺血组织。方法:纳入急性大脑中动脉(MCA)脑梗死患者40例,采用随机对照的方法将被试分为HUK治疗组和对照组,每组各20例,于治疗前1天、治疗后第7天及第30天采集两组被试的扩散加权成像(DWI)和灌注加权成像(PWI)图像,比较两组治疗前后梗死中心区和缺血半暗带区的血流灌注情况。然后采用对比剂增强MRA(CE-MRA)技术比较两组治疗前后梗死周围区软脑膜侧支循环的建立情况。结果:1治疗后两组被试梗死中心区和缺血半暗带区的局部脑血流(r CBF)值均较治疗前增加,但与对照组相比,HUK治疗组增加更为明显,且治疗后两组间缺血组织r CBF值的差异有统计学意义(梗死中心区:0.86±0.43 vs 0.54±0.13,P<0.05;缺血半暗带区:2.11±0.36 vs 1.03±0.61,P<0.05)。2采用CE-MRA技术可显示侧裂和大脑半球凸面软脑膜侧支循环的建立,HUK治疗组侧支血管建立的评分较对照组明显提高(4.3±0.5 vs 3.2±0.7,P<0.05)。结论:HUK可有效改善急性脑梗死患者缺血组织的侧支循环和血流灌注;CE-MRA技术有望成为侧支血管成像的新手段。
Objective: To investigate the effect of human urokinase (HUK) on collateral circulation and cerebral perfusion in patients with acute cerebral infarction in order to find new drugs to effectively open the collateral circulation and save the ischemic tissue. Methods: Forty patients with acute cerebral infarction (MCA) were enrolled in this study. The subjects were randomly divided into HUK treatment group and control group, 20 cases in each group. One day before treatment and 7 days after treatment And diffusion-weighted imaging (DWI) and perfusion weighted imaging (PWI) images of the two groups were collected on the 30th day. The blood perfusion in the infarct center and the ischemic penumbra of the two groups were compared. Contrast-enhanced MRA (CE-MRA) technique was then used to compare the establishment of the pia mater collateral circulation around the infarct zone in both groups before and after treatment. Results: After treatment, the mean CBF rCFF in both central infarct and ischemic penumbra in both groups increased compared with those before treatment, but the levels of r CBF increased more significantly in the HUK group than those in the control group The difference of r CBF between the two groups after treatment was statistically significant (infarct center: 0.86 ± 0.43 vs 0.54 ± 0.13, P <0.05; ischemic penumbra: 2.11 ± 0.36 vs 1.03 ± 0.61, P <0.05). 2 CE-MRA was used to show the establishment of scoliosis and the convex cerebral pia mater collateral circulation. The score of collateral vessels in HUK group was significantly higher than that in control group (4.3 ± 0.5 vs 3.2 ± 0.7, P <0.05). Conclusion: HUK can effectively improve collateral circulation and perfusion of ischemic tissue in patients with acute cerebral infarction. CE-MRA is expected to become a new means of collateral vessel imaging.