Objective To assess the efficacy and safety of human urinary kallidinogenase injection (HUK) in treating patients with acute ischemic stroke. Methods Through adopting Cochrane systematic review methods, the relevant materials were retrieved by electronically and manually searching databases and claimed from pharmaceutical factories, so as to collect the randomized controlled trials (RCTs) about HUK for the patients with acute ischemic stroke, which were searched by the end of October 2010. The quality of each trial was assessed by two reviewers independently, and meta-analysis was conducted by using RevMan 5.0.2 software. Results Twenty-four trials involving 2 433 patients were included, of which 2 were multi-center placebo controlled trials, and the other 22 were all non-placebo trials. Only 2 trials (459 cases) reported the death or dependence at the end of 3-month follow-up. In those trials, HUK reduced death or dependency comparing to the control group (RR=0.69, 95%CI 0.55 to 0.86). Twenty trials (2 117 patients) reported the proportion of patients with marked neurological improvement after finishing the 7 to 21 days treatment. Meta-analysis showed the HUK group had more neurological improvement than the control group, with significant differences (RR=1.56, 95%CI 1.44 to 1.70). Fifteen trials reported adverse events, of which the transient hypotension was commonly seen (1.5%-5.1%). Non-fatal intracerebral hemorrhage was detected in 7 patients in 3 trials, but the difference between the HUK group (6 patients, 1.2%) and the control group (1 patient, 0.4%) was not significant (RR=1.82, 95%CI 0.34 to 9.61). Deaths occurred in both HUK group (2 patients, 0.4%) and the control group (1 patient, 1.1%) in 2 trials, without significant differences (RR=0.6, 95%CI 0.09 to 3.92). No trial assessed quality of life. Conclusion Available evidence suggests that HUK injection reduces neurological impairment after acute ischemic stroke and improves long-term outcomes, though a few patients suffer from transient hypotension. Further high-quality, large-scale RCTs are needed to confirm these results.
目的 探讨尤瑞克林对不同结构性影像类型进展性脑梗死的CT与临床效果。 方法 2007年3月－2011年6月按入院时不同结构性影像类型将进展性脑梗死分为大灶梗死、中灶梗死、小灶梗死及腔隙梗死4型，共235例，采用分层随机分组的方法将患者分为尤瑞克林组（治疗组）119例，对照组116例。两组基础用药均为疏血通6 mL+生理盐水250 mL静脉滴注，胞磷胆碱0.5 g+生理盐水250 mL静脉滴注，阿司匹林0.1 g口服，以上用药均为1次/d，连用4周。治疗组同时给予生理盐水100 mL+尤瑞克林0.15 PNAu静脉滴注，对照组同时给予生理盐水100 mL静脉滴注，1次/d，连用7～14 d，两组治疗前后均测量梗死的最大层面最大梗死灶的长度与宽度，计算并记录梗死面积；统计分析各型的临床疗效。 结果 ① 梗死面积改变：治疗前各亚型治疗组与对照组梗死面积差异均无统计学意义（P＞0.05）；治疗后，大灶梗死组、中灶梗死组、小灶梗死组中的治疗组梗死面积均比治疗前显著缩小（P＜0.01），而对照组的梗死面积较治疗前差异无统计学意义（P＞0.05）；腔隙梗死组中，治疗组及对照组治疗后梗死面积均无明显改变（P＞0.05）。② 临床疗效：各亚型进展性脑梗死，治疗组均取得优于对照组的效果；大灶梗死及中灶梗死的显著进步率分别为47.6%和66.7%，而对照组的显著进步率分别为0.0%和33.3%。 结论 大灶梗死组、中灶梗死组、小灶梗死组进展性脑梗死使用尤瑞克林治疗后梗死面积均比治疗前明显缩小；各亚型进展性脑梗死使用尤瑞克林后临床疗效均优于对照组，尤其是大灶梗死及中灶梗死的临床效果更加显著。