Objective To explore the influence of kallilrein on cerebral hemodynamics,matrix metalloproteinases (MMPs) and the clinical efficacy in patients with large-area cerebral infarction.Methods Totally 127 patients with large-area cerebral infarction from March 2011 to September 2014 were enrolled and randomly divided into control group (64 cases) receiving conventional treatment and observation group (63 cases) administrated with kallilrein (0.15 PNA unit dissolved in 0.9％ sodium chloride injection,40 drops/min,1 time/d for 14 d)in addition to conventional treatment.The parameters of cerebral hemodynamics and the levels of MMP-1,MMP-2,MMP-9 before trcatment,7 d,14 d,21 d,28 d and 3 months after treatment were compared between the two groups.The short-term (28 d after treatment) and long-term (3 months after treatment) outcomes were compared between the two groups.Results No changes were shown regarding the mean velocity (Vm),peak systolic velocity ratio of anterior cerebral artery and posterior cerebral artery after treatment in both groups (all P ＞ 0.05).Compared with those before treatment,the Vm of middle cerebral artery (MCA) and terminal internal carotid artery (TICA) 7 d,14 d,21 d,28 d and 3 months after treatment,the mean flow (Qm) 14 d,21 d,28 d and 3 months after treatment were significantly improved in both control group [Vm of MCA:(27 ± 10),(28 ± 13),(30 ± 13),(35 ±12),(36 ±9) cm/s vs (24±8) cm/s,Vm of TICA:(40±13),(41 ±8),(43 ± 13),(44±13),(45±10) cm/s vs (35±14) cm/s,Qm:(6.8±2.3),(7.2±2.1),(7.6±2.4),(8.0±1.7) ml/min vs (6.2 ± 1.8) ml/min] and observation group [Vm of MCA:(27 ±5),(35 ±8),(39 ± 11),(45 ± 10),(46 ± 9) cm/svs (24 ±7) cm/s,Vm of TICA:(41 ±10),(45 ±9),(49±14),(54±12),(55 ±9) cm/s vs (34 ±8) cm/s,Qm:(7.6 ±2.4),(8.1 ± 1.2),(8.8 ± 1.4),(9.0± 1.2) ml/min vs (6.5 ± 1.3) ml/min] (all P ＜0.05); there were significantly differences regarding those outcomes between the two groups 14 d after treatment.Compared with those before treatment,the pulsatility index (PI) was improved 7 d,14 d,21 d,28 d and 3 months after treatment in observation group (1.41 ± 0.27,1.21 ± 0.44,1.11 ± 0.21,1.03 ± 0.17,1.10 ±0.21 vs 1.75 ±0.36) ; it was improved 21 d,28 d and 3 months after treatment in control groups (1.51 ± 0.14,1.38 ±0.15,1.27 ±0.08 vs 1.81 ±0.12) ; there were significantly differences regarding PI between the two groups after treatment (all P ＜ 0.05).Fourteen days after treatment,the dynamic resistance was improved significantly in both control group (301 ±84,285 ±78,256 ±96,250±77 vs 326 ±90,362 ±72,339 ±79,321 ± 85,311 ± 74 vs 389 ± 84) and observation group (283 ± 92,264 ± 87,228 ± 85,225 ± 83 vs 327 ± 74; 342 ± 94,312 ±86,287 ±75,285 ±58 vs 391 ±96),with significant differences between the two groups (all P ＜ 0.05).The levels of MMP-1,MMP-2,and MMP-9 in observation group were significantly lower than those in control group since 14 d after treatment,all lower than pretreatment (all P ＜ 0.05).The short-term and long-term marked rates in observation group were higher than those in control group [34.9％ (22/63) vs 15.6％ (10/64),47.6％ (25/63) vs 15.6％ (10/64)],so did the total effective rates [73.0％ (46/63) vs 53.1％ (34/64),84.1％ (53/63) vs 62.5％ (40/64)] (P ＜0.05).Conclusion Kallilrein can improve the parameters of cerebral hemodynamics and the MMPs level,which has significant therapeutic effects in the short and long term.%目的 探讨尤瑞克林对老年大面积脑梗死患者脑血流动力学和金属基质蛋白酶(MMP)的影响及其近期和远期疗效.方法 纳入2011年3月至2014年9月湖北省襄阳市中心医院大面积老年脑梗死患者127例,按随机数字表法分为对照组(64例)和观察组(63例),对照组给予常规药物治疗,观察组在常规治疗的基础上加用尤瑞克林(0.15 PNA单位溶于100 ml 0.9％氯化钠注射液中,40滴/min静脉滴注,1次/d,连续用药14 d).于治疗前,治疗后7、14、21、28 d和3个月采用经颅多普勒超声检查患者血流动力学变化情况,检测血清MMP-1、MMP-2和MMP-9水平,于治疗后28 d和3个月评估近期和远期疗效.结果 2组患者治疗前后大脑前动脉和大脑后动脉平均血流速度(Vm)、两侧大脑前动脉和大脑后动脉收缩峰流速比值均无明显改变,2组间比较差异亦无统计学意义(均P ＞0.05);与治疗前比较,2组治疗后7、14、21、28 d和3个月大脑中动脉Vm[对照组:(27±10)、(28±13)、(30±13)、(35±12)、(36±9) cm/s比(24±8)cm/s,观察组:(27±5)、(35 ±8)、(39±l1)、(45±10)、(46 ±9) cm/s比(24±7)cm/s]和颈内动脉末端Vm[对照组:(40±13)、(41±8)、(43±13)、(44±13)、(45±10) cm/s比(35±l4)cm/s,观察组:(41±10)、(45±9)、(49±14)、(54±l2)、(55±9) cm/s比(34±8)cm/s]、治疗后14、21、28 d和3个月平均血流量(Qm)[对照组:(6.8±2.3)、(7.2±2.1)、(7.6±2.4)、(8.0±1.7)ml/min比(6.2±1.8) ml/min,观察组:(7.6±2.4)、(8.1±1.2)、(8.8±1.4)、(9.0±1.2) ml/min比(6.5±1.3) ml/min]明显改善(均P＜0.05),治疗后14 d起2组间上述指标差异均有统计学意义(均P＜0.05);观察组治疗后7d、14 d、21 d、28 d和3个月脉动指数(PI)明显改善(1.41 ±0.27、1.21±0.44、1.11±0.21、1.03 ±0.17、1.10±0.21比1.75 ±0.36,均P＜0.05),而对照组治疗后21 d、28 d和3个月明显改善(1.51 ±0.14、1.38±0.15、1.27 ±0.08比1.81±0.12,均P＜0.05),2组间治疗后PI差异均有统计学意义(均P＜0.05);与治疗前比较治疗后14 d起2组血管特性阻抗(对照组:301±84、285±78、256±96、250±77比326±90,观察组:283±92、264±87、228±85、225±83比327±74)和动态阻力(对照组:362±72、339±79、321±85、311±74比389±84,观察组:342 ±94、312±86、287 ±75、285±58比391±96)水平均明显改善(均P＜0.05),且观察组明显低于对照组(均P＜0.05).与治疗前比较,2组治疗14 d起血清MMP-1、MMP-2和MMP-9水平逐渐降低(均P ＜0.05),2组间比较差异有统计学意义(均P＜0.05).观察组近期和远期显效率明显高于对照组[34.9％(22/63)比15.6％ (10/64),47.6％ (25/63)比15.6％ (10/64),均P＜0.01],总有效率亦明显高于对照组[73.0％(46/63)比53.1％(34/64),84.1％(53/63)比62.5％ (40/64),均P＜0.05].结论 尤瑞克林可明显改善大面积脑梗死患者血流动力学指标和MMP水平,且近远期疗效明显.
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