| 张佳,李浩,余广兰,等.替奈普酶与阿替普酶静脉溶栓联合机械取栓治疗急性大血管闭塞性缺血性卒中的临床疗效对比研究[J].安徽医药,2026,30(6):1188-1193. |
| 替奈普酶与阿替普酶静脉溶栓联合机械取栓治疗急性大血管闭塞性缺血性卒中的临床疗效对比研究 |
| A comparative study on the clinical efficacy of tenecteplase versus ateplase for intravenous thrombolysis combined with mechanical thrombectomy in acute ischemic stroke with large vessel occlusion |
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| DOI：10.3969/j.issn.1009-6469.2026.06.025 |
| 中文关键词: 脑梗死 脑卒中 阿替普酶 替奈普酶 静脉溶栓 机械取栓 |
| 英文关键词: Brain infarction Stroke Alteplase Tenecteplase Intravenous thrombolysis Mechanical thrombectomy |
| 基金项目: |
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| 摘要点击次数: 61 |
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| 中文摘要: |
| 目的比较替奈普酶与阿替普酶静脉溶栓联合机械取栓治疗急性大血管闭塞性缺血性卒中( AIS-LVO)的临床疗效。方法选取 2021年 2月至 2023年 6月宜宾市第一人民医院收治的 96例 AIS-LVO病人，根据静脉溶栓药物不同将其分为阿替普酶组(A组)和替奈普酶组( T组)，各 48例。 A组予以阿替普酶静脉溶栓联合机械取栓治疗； T组予以替奈普酶静脉溶栓联合机械取栓治疗。比较两组血管再通率、血清学指标［白细胞介素 -6(IL-6)、肿瘤坏死因子 α(TNF-α)、神经元特异性烯醇化酶(NSE)、 S-100β］、脑梗死体积、美国国立卫生研究院卒中量表( NIHSS)评分、改良 Rankin量表( mRS)评分、 36项健康调查简表(SF-36)评分、巴塞尔指数、 24 h内的症状性颅内出血发生率和 90 d全因死亡发生率。结果 T组血管再通率 93.75%(45/48)高于 A组 72.92%(35/48)(P<0.05)； T组治疗后 1、7、14 d血清 TNF-α［( 9.29±1.84)ng/L、(7.52±1.65)ng/L、(5.68±1.63)ng/L］、 IL-6［( 141.36±15.79)ng/L、(123.35±15.05)ng/L、(86.37±11.79)ng/L］、 NSE［( 7.87±1.58)μg/L、(5.96±0.96)μg/L、(4.62±1.14)μg/L］、 S-100β［(0.77±0.11)μg/L、(0.62±0.13)μg/L、(0.42±0.08)μg/L］低于 A组血清 TNF-α［(11.43±2.11)ng/L、(9.17±1.78)ng/L、(7.23± 1.89)ng/L］、 IL-6［( 163.20±22.49)ng/L、(139.12±15.73)ng/L、(113.81±16.58)ng/L］、 NSE［( 9.72±1.86)μg/L、(7.52±1.43)μg/L、(6.89±1.35)μg/L］、 S-100β［( 0.85±0.13)μg/L、(0.72±0.11)μg/L、(0.62±0.12)μg/L］(P<0.05)； T组治疗后 14 d脑梗死体积( 2.36± |
| 英文摘要: |
| Objective To compare the clinical efficacy of tenecteplase versus ateplase for intravenous thrombolysis combined withmechanical thrombectomy in the treatment of acute ischemic stroke with large vessel occlusion (AIS-LVO). Methods A total of 96 AIS-LVO patients admitted to Yibin First People's Hospital from February 2021 to June 2023 were enrolled and divided into anateplase group (Group A) and a tenecteplase group (Group T) based on the intravenous thrombolytic agent used, with 48 cases in eachgroup. Group A received intravenous thrombolysis with ateplase combined with mechanical thrombectomy. Group T received intrave.nous thrombolysis with tenecteplase combined with mechanical thrombectomy. The following outcomes were compared between groups:vascular recanalization rate, serological indicators [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), neuron specific enolase (NSE), S-100β], cerebral infarction volume, National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin scale (mRS) score, 36-item short form health survey (SF-36) score, Barthel index, incidence of symptomatic intracranial hemorrhage within 24 hours, and 90-day all-cause mortality.Results The vascular recanalization rate was higher in Group T (93.75%, 45/48) than in Group A (72.92%, 35/48) (P<0.05). At 1, 7, and 14 days post-treatment, serum levels of TNF-α [(9.29±1.84) ng/L, (7.52±1.65) ng/L, (5.68± 1.63) ng/L], IL-6 [(141.36±15.79) ng/L, (123.35±15.05) ng/L, (86.37±11.79) ng/L], NSE [(7.87±1.58) μg/L, (5.96±0.96) μg/L, (4.62±1.14) μg/L] and S-100β [(0.77±0.11) μg/L, (0.62±0.13) μg/L, (0.42±0.08) μg/L] were significantly lower in group T were lower than in Group A [TNF-α: (11.43±2.11) ng/L, (9.17±1.78) ng/L, (7.23±1.89) ng/L, IL-6: (163.20±22.49) ng/L, (139.12±15.73) ng/L, (113.81± 16.58) ng/L, NSE: (9.72±1.86) μg/L, (7.52±1.43) μg/L, (6.89±1.35) μg/L, S-100β: (0.85±0.13) μg/L, (0.72±0.11) μg/L, (0.62±0.12) μg/L] (P<0.05). The cerebral infarction volume at 14 days post-treatment was smaller in Group T [(2.36±0.43) cm3] than in Group A [(4.47± 1.12) cm3] (P<0.05). NIHSS score at 1, 7 and 90 days post-treatment were significantly lower in Group T [(12.21±2.03) scores, (9.31±1.56) scores, (6.63±1.50) scores] than in group A [(14.29±2.40) scores, (12.08±1.51) scores, (9.17±1.91) scores] (P<0.05). The propor. tion of patients with a favorable prognosis (mRS score 0-2) at 90 days was higher in Group T [64.58% (31/48)] than in Group A [41.67% (20/48)] (P<0.05). At 90 days post-treatment, SF-36 scores [(85.94±8.22)] and Barthel index scores [(84.56±6.20)] were significantly higher in Group T than in Group A [SF-36: (74.67±7.57); Barthel index: (73.98±6.31)] (P<0.05). There were no statistically significantdifferences between the groups in the incidence of symptomatic intracranial hemorrhage within 24 hours [Group T: 10.42% (5/48) vs. Group A: 14.58% (7/48)] or 90-day all-cause mortality [Group T: 14.58% (7/48) vs. Group A: 16.67% (8/48)] (P>0.05). Conclusion For AIS-LVO patients undergoing bridging therapy, intravenous thrombolysis with tenecteplase, compared to alteplase, is associatedwith higher vascular recanalization rates, better control of inflammatory response, smaller cerebral infarction volume, greater neurologi.cal recovery, improved prognosis, and enhanced daily living ability and quality of life, with a comparable safety profile. |
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