Yasaka M, O'Keefe G J, Chambers B R, Davis S M, Infeld B, O'Malley H, Baird A E, Hirano T, Donnan G A
Department of Neurology, Austin & Repatriation Medical Centre, Melbourne, Victoria, Australia.
Neurology. 1998 Mar;50(3):626-32. doi: 10.1212/wnl.50.3.626.
The Australian Streptokinase Trial was a randomized, double-blind, placebo-controlled trial, in which streptokinase (SK, 1.5 million IU I.V.) was given within 4 hours of stroke onset. In a subset of 37 patients, 99mTc-labeled D,L-hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) and/or transcranial Doppler (TCD) studies were performed before and after therapy to test the hypothesis that SK may improve the hemodynamic measures of reperfusion/recanalization rates (TCD parameter) within 24 hours. Eighteen patients received SK and 19 placebo. Baseline characteristics were similar in both groups, and there were no differences in clinical outcomes assessed at 3 months after stroke. Although there was no increase in the group mean perfusion defect or volume on SPECT after thrombolytic therapy, a larger number of patients demonstrating the combined end point of reperfusion or recanalization was seen in the SK group (13/14, 93%) than in the placebo group (7/14, 50%; p = 0.01). Although SK given within 4 hours of acute ischemic stroke appears to improve arterial patency/tissue reperfusion, this effect is neither early nor extensive enough to influence overall clinical outcome.
澳大利亚链激酶试验是一项随机、双盲、安慰剂对照试验，在该试验中，链激酶（SK，150万国际单位静脉注射）在卒中发作后4小时内给药。在37例患者的亚组中，治疗前后进行了99mTc标记的D，L-六甲基丙烯胺肟单光子发射计算机断层扫描（SPECT）和/或经颅多普勒（TCD）研究，以检验SK可能在24小时内改善再灌注/再通率（TCD参数）的血流动力学指标这一假设。18例患者接受SK治疗，19例接受安慰剂治疗。两组的基线特征相似，卒中后3个月评估的临床结局无差异。虽然溶栓治疗后SPECT组的平均灌注缺损或体积没有增加，但与安慰剂组（7/14，50%；p=0.01）相比，SK组中显示再灌注或再通联合终点的患者数量更多（13/14，93%）。虽然在急性缺血性卒中发作后4小时内给予SK似乎可改善动脉通畅度/组织再灌注，但这种作用既不早期也不够广泛，不足以影响总体临床结局。
