替奈普酶与阿替普酶静脉溶栓治疗高龄急性缺血性脑卒中患者的对比研究OA

Objective To compare the safety and efficacy of tenecteplase(TNK)versus alteplase(rt-PA)for intravenous thrombolysis in elderly patients with acute ischemic stroke(AIS).Methods A retrospective study was conducted involving 403 elderly patients with AIS admitted to the Department of Neurology,Xingtai Central Hospital between January 2023 and January 2025.Participants were divided into experimental group(intravenous TNK thrombolysis,n=204)and control group(intravenous rt-PA thrombolysis,n=199)based on treatment modality.Within the experimental group,patients aged＜80 years were categorized as Group 1(n=152)and those aged ≥80 years as Group 2(n=52).In the control group,patients aged＜80 years comprised Group 3(n=149)and those aged ≥80 years Group 4(n=50).The following parameters were compared across groups:symptomatic intracranial hemorrhage(sICH)incidence,systemic bleeding event incidence,48-hour mortality,90-day mortality;Biomarker levels:D-dimer,C-reactive protein(CRP),N-terminal pro-B-type natriuretic peptide(NT-proBNP),matrix metalloproteinase-9(MMP-9),glial fibrillary acidic protein(GFAP),proportion of patients with modified Rankin scale(mRS)score ≤2 at 90 days,24-hour NIHSS improvement rate,90-day revascularization rate,the length of hospital stay.Results No significant differences were observed between the experimental group and the control group in sICH incidence,systemic bleeding events,48-hour mortality,or 90-day mortality(P＞0.05).No significant intergroup differences in D-dimer,CRP,NT-proBNP,MMP-9,or GFAP levels pre-thrombolysis(P＞0.05).After thrombolysis,D-dimer and NT-proBNP levels decreased significantly in both groups,with lower values in the experimental group(P＜0.05).MMP-9,GFAP,and CRP levels increased significantly in all groups,but were markedly higher in the control group(P＜0.05).The experimental group demonstrated significantly higher rates of favorable functional outcome(mRS ≤2 at 90 days)and revascularization(P＜0.05).No significant differences were found in 24-hour NIHSS improvement rates or length of hospitalization(P＞0.05).Conclusion For elderly AIS patients,TNK demonstrates comparable safety to rt-PA but offers superior long-term neurological outcomes and vascular recanalization.The advantages of TNK may be attributed to its greater efficacy in reducing the expression of neurotoxic biomarkers and inflammatory responses.