阿替普酶与替奈普酶对老年急性缺血性脑卒中的疗效及预后的比较OA
Comparison of the efficacy and prognosis of alteplase and tenecteplase in elderly patients with acute ischemic stroke
目的 比较阿替普酶(rt-PA)与替奈普酶(TNK-tPA)对老年急性缺血性脑卒中(AIS)的疗效及预后.方法 将86 例老年 AIS 患者随机分为 TNK-tPA 组43 例与 rt-PA 组43 例.比较两组的溶栓关键时间指标[门-针时间(DNT)、药物配制与操作时间]、操作相关不良事件、临床疗效、神经功能缺损情况、神经因子表达[神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白 β(S-100β)]、整体神经功能残疾程度及溶栓后并发症.结果 rt-PA 组及 TNK-tPA 组溶栓后 7d 的临床疗效差异无统计学意义(P<0.05).与 rt-PA 组比较,TNK-tPA 组溶栓前 NIHSS 差异无统计学意义(P>0.05),溶栓后 1 h、24 h、7 d 及出院时 NIHSS 评分显著降低(P<0.05～0.01).与 rt-PA 组比较,TNK-tPA 组溶栓后7d 血清 NGF 水平显著升高,NSE、S-100β 水平显著降低(均 P<0.001).rt-PA 组及 TNK-tPA 组操作相关不良事件发生率差异有统计学意义(t=4.195,P=0.041),溶栓后并发症发生率差异无统计学意义(t=1.124,P=0.289),出血相关并发症发生率差异无统计学意义(χ2=0.816,P=0.366).与 rt-PA 组比较,TNK-tPA 组 DNT 及配制与操作时间显著降低(均P<0.05).与rt-PA 组比较,TNK-tPA 组溶栓前及溶栓后30 d mRS 评分差异无统计学意义(均P>0.05),溶栓后90 d mRS 评分显著降低(P<0.05).结论 TNK-tPA 与 rt-PA 在老年 AIS 患者的治疗中均能取得较好的临床疗效,但 TNK-tPA 治疗可更好改善患者预后,且操作更便利.
Objective To compare the efficacy and prognosis of alteplase(rt-PA)and tenecteplase(TNK-tPA)in elderly patients with acute ischemic stroke(AIS).Methods Eighty-six elderly patients with AIS were randomly divided into the TNK-tPA group(n=43)and the rt-PA group(n=43).The key time indexes of thrombolysis[door-to-needle time(DNT),drug preparation and operation time],operation-related adverse events,clinical efficacy,neurological deficit,nerve factor expression[nerve growth factor(NGF),neuron-specific enolase(NSE),central nervous system specific protein β(S-100β)],overall neurological disability and complications after thrombolysis were compared between the two groups.Results There was no significant difference in clinical efficacy between the rt-PA group and the TNK-tPA group at 7 d after thrombolysis(P<0.05).Compared with those in the rt-PA group,there was no significant difference in NIHSS before thrombolysis in the TNK-tPA group(P>0.05),and the NIHSS scores at 1 h,24 h,7 d after thrombolysis and at discharge were significantly decreased(P<0.05-0.01).Compared with those in the rt-PA group,the serum NGF level in the TNK-tPA group was significantly increased at 7 d after thrombolysis,and the NSE and S-100β levels were significantly decreased(all P<0.001).There was a statistically significant difference in the incidence of procedure-related adverse events between the rt-PA group and the TNK-tPA group(t=4.195,P=0.041);there was no statistically significant difference in the incidence of complications after thrombolysis(t=1.124,P=0.289),and there was no statistically significant difference in the incidence of hemorrhage-related complications(χ2=0.816,P=0.366).Compared with those in the rt-PA group,DNT and drug preparation and operation time in the TNK-tPA group were significantly decreased(all P<0.05).Compared with those in the rt-PA group,there was no significant difference in mRS score before and 30 d after thrombolysis in the TNK-tPA group(all P>0.05),and the mRS score was significantly decreased at 90 d after thrombolysis(P<0.05).Conclusion TNK-tPA and rt-PA can achieve good clinical efficacy in the treatment of elderly AIS patients,but TNK-tPA treatment can better improve the prognosis of patients,and the operation is more convenient.
孟燕;庞玉明;刘婷婷;王玮玮;魏玉清
054000 邢台市中心医院神经内科二病区邢台医学院第二附属医院呼吸与危重症医学科054000 邢台市中心医院神经内科二病区054000 邢台市中心医院神经内科二病区054000 邢台市中心医院神经内科二病区
医药卫生
急性缺血性脑卒中替奈普酶阿替普酶溶栓效率预后
acute ischemic stroketenecteplasealteplasethrombolytic efficiencyprognosis
《临床神经病学杂志》 2026 (4)
264-268,5
邢台市重点研发计划自筹项目(2025ZC357)
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