替奈普酶与阿替普酶治疗急性缺血性卒中短期神经功能恢复比较:线性混合效应模型分析OA

Objective To analyze the early therapeutic effects of tenecteplase versus alteplase in patientswith acute ischemic stroke (AIS),clarify the efficacy differences between the two intravenousthrombolytic agents,and provide evidence-based references for the individualized selection ofclinical intravenous thrombolysis regimens. Methods Patients with AIS who received intravenous thrombolysis in the Department ofNeurology,Central Hospital Affiliated to Shenyang Medical College from January 2020 toDecember 2023 were retrospectively and consecutively enrolled. These patients were divided intoa tenecteplase group and an alteplase group according to the medication regimen. Baseline dataof the two groups were collected,including age,gender,past medical history,onset-to-needle time,and baseline NIHSS score. NIHSS scores were recorded at baseline and multiple time pointsafter intravenous thrombolysis (24 h,72 h,7 d,14 d,90 d). A linear mixed-effects model was usedfor statistical analysis,with a focus on the effect of the group×time interaction term on the rate ofneurological function recovery. Meanwhile,residual normality test,homogeneity of variance test,multicollinearity diagnosis,and leave-one-out robustness validation were performed to ensure thereliability of the model. Results A total of 580 AIS patients were included,with 300 (51.7％) in the tenecteplase group and280 (48.3％) in the alteplase group. Compared with the alteplase group,the tenecteplase group hadsignificantly higher baseline NIHSS scores[(16.2±4.5) points vs. (14.1±4.2) points]and a higherproportion of patients with a history of atrial fibrillation (28.3％ vs. 20.7％),with both differencesstatistically significant (both P<0.05). Linear mixed-effects model analysis showed that:①Themain effect of group was significant (β=1.80,95％CI 0.27-3.33,P=0.03),and the NIHSS score inthe tenecteplase group was significantly higher than that in the alteplase group at baseline;②Themain effect of time was significant (β=-0.60,95％CI-0.72--0.48,P<0.01),indicating that theNIHSS scores of both groups showed a downward trend over time;③The group×time interactioneffect was significant (β=-0.40,95％CI-0.63--0.17,P<0.01),suggesting that the NIHSSscores decreased more rapidly in the tenecteplase group than in the alteplase group;④Amongthe covariate effects,age (β=0.08,95％CI 0.02-0.14,P=0.02) and baseline NIHSS score (β=0.85,95％CI 0.67-1.03,P<0.01) were independent influencing factors for neurological function recovery.Model validation results indicated a good goodness of fit. Conclusions After adjusting for baseline confounding factors,tenecteplase achieves faster shorttermneurological function recovery than alteplase in AIS patients,and thus can serve as one of thepreferred regimens for intravenous thrombolysis in ultra-early AIS (onset≤4.5 h).