Human Urinary Kallidinogenas Injection For Acute Ischemic Stroke:a Meta-analysis

Stroke has become the first cause of death in our country, and alsoan important cause of disability.Due to ischemic stroke accounts for80%of all stroke types, and therefore, the treatment of acute cerebralinfarction patients to improve quality of life, reduce morbidity hasimportant significance. Drugs in the treatment of acute cerebralinfarction, anti-platelet drug aspirin and thrombolytic drug recombinanttissue-type plasminogen activator (rt-PA) have become the internationalA-level evidence in nation guidelines, recommended grade Ⅰ.Othertreatments including anticoagulant, scavenging free radicals, improvingcirculation, cerebral protection,e.t.have not such sufficient evidence tomeet the class A-level of evidence and recommended Ⅰgrade level.Therefore, a systematic evaluation of these drugs is particularlynecessary.Although rt-PA as the U.S. Food and Drug Administration (FDA)approval applied effective drug treatment of acute cerebral infarction, butits application is limited strictly by the therapeutic window, the risk ofbleeding and can not improve the prognosis for most patients. After abasic treatment of anti-platelet, anticoagulant, scavenging free radicals,improving circulation and others, patients with acute cerebral infarctionstill legacy neurological deficit symptoms. Therefore, the neurovascularinjury and repair mechanisms after the occurrence of ischemic stroke andthe treatment of drug-related research process are still going on. Uribetissue kallikrein1(hK1) is the main component of Urinary Kallidinogenase. At the initial stage of UK applied in the treatment ofacute cerebral infarction. There were some domestic randomizedcontrolled trials aiming at analysing its effectiveness and safety and apreparatory a systematic review of its early using. Recently UK has beenmore widely used in China, and the number of corresponding clinicalrandomized controlled trial (RCT) is constantly increasing, but lacks ofan updating systematic reviews to provide the evidence of its broaderapplication.In this study,we use computer and manual ways to search theapplication of UK from the beginning to the latest randomized controlledtrials. Through the development of inclusion and exclusion criteria, weselect the relevant literature, collect relevant data included in the studybased on the data extraction form and use the software Revman5.2calculate the value of the combined effect of the RR and95%CI.Weanalysis the randomized controlled trials from the January2008-January2013to update the system review by meta-analysis.The result shows that18trials involving1,898patients wereincluded, which covers more than10provinces of China, all the trialsreported the proportion of patients with marked neurologicalimprovement after finishing the7to14days’ treatment. Meta-analysisshowed the HUK group had more neurological improvement than thecontrol group, with significant differences (RR=1.25,95%CI1.19to1.31).14trials reported adverse events, of which the transient hypotension wascommonly seen, were improved after symptomatic treatment, nointracranial hemorrhage and other significant adverse reactions anddeath.Available evidence suggests that HUK injection in randomizedcontrolled trials reduces neurological impairment after acute ischemic stroke significantly, compared with control group have higher efficiencyand safety，but still need more high quality randomized controlled trials toverify.