人尿激肽原酶对急性脑梗死侧支循环与#br# 脑血流灌注影响的多模态MRI研究

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摘要目的：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（rCBF）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rCBF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。

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关键词 ：脑梗塞, 尿纤溶酶原激活物, 侧支循环, 磁共振成像

Abstract：Objective: To explore the impact of human urinary kallidinogenase(HUK) on collateral circulation and blood perfusion in patients with acute cerebral infarction in order to find a new kind of medicine with great efficiency in building collateral circulation and saving ischaemic penumbra. Methods: Forty patients with acute cerebral infarction of middle cerebral artery(MCA) were selected in the study and divided into two groups with the randomized controlled method. Each group included twenty patients. Diffusion weighted imaging(DWI) and perfusion weighted imaging(PWI) images of all the participants were collected one day before treatment, the seventh day and the thirtieth day after treatment. We first compared the differences of blood perfusion in ischaemic core and ischaemic penumbra before and after treatment between the two groups. Then we compared the establishment of collateral circulation in peripheral regions of infarction between the two groups using contrast enhance MRA(CE-MRA) technology. Results: ①Compared with before treatment, the regional cerebral blood flow(rCBF) value in ischaemic core and ischaemic penumbra of both the groups increased significantly after treatment. However, group with HUK treatment had a more obvious increase of rCBF value in ischaemic tissues and the differences of rCBF value after treatment between the two groups are statistically significant(ischaemic core: 0.86±0.43 vs 0.54±0.13, P<0.05; ischaemic penumbra: 2.11±0.36 vs 1.03±0.61, P<0.05). ②Using CE-MRA, the establishment of leptomeningeal collateral circulation in lateral fissure and lateral surface of hemishere was showed and the grade of collateral circulation in group with HUK treatment improved significantly(4.3±0.5 vs 3.2±0.7, P<0.05). Conclusion: HUK can efficiently improve collateral circulation and blood perfusion of ischaemic tissues in patients with acute cerebral infarction. CE-MRA technology is likely to be a new method for evaluating the establishment of collateral vessels.

Key words： Brain infarction Urinary plasminogen activator Collateral circulation Magnetic resonance imaging

收稿日期: 2015-07-06

PACS:
	Ｒ743.33
	Ｒ445.2

基金资助:国家自然科学基金项目（31371007，81430037）；北京市科委首都市民健康培育项目（Z131100006813022）；凯力康医学研究项目（201206006）；国家重点基础研究发展计划（973）2010CB732600；国家科技支撑计划 2012BAI10B00。

通讯作者: 韩璎

作者简介: 盛灿（1989-），女，山东人，硕士研究生。E-mail：canyeweiwu2013@163.com

引用本文:

盛灿1，李瑜霞1，谢云燕1，张忠敏2，孙宇1，王晓妮1，李红艳1，李轩宇1，. 人尿激肽原酶对急性脑梗死侧支循环与#br# 脑血流灌注影响的多模态MRI研究[J]. 中国临床医学影像杂志, 2016, 27(2): 77-81.
SHENG Can1, LI Yu-xia1, XIE Yun-yan1, ZHANG Zhong-min2, SUN Yu1, WANG Xiao-ni1, LI Hong-yan1, . Multi-modality MRI study about the impact of human urinary kallidinogenase on collateral circulation and #br# blood perfusion in patients with acute cerebral infarction. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(2): 77-81.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2016/V27/I2/77

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