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| 替奈普酶与阿替普酶在急性缺血性卒中患者桥接治疗中的疗效比较 |
| Comparison of the efficacy of tenecteplase and alteplase in bridging therapy for patients with acute ischemic stroke |
| 投稿时间：2025-07-20 修订日期：2025-07-20 |
| DOI： |
| 中文关键词: 桥接治疗 急性缺血性脑卒中 替奈普酶 阿替普酶 |
| 英文关键词: bridging therapy acute ischemic stroke tenecteplase alteplase |
| 基金项目:徐州市科技项目（后循环大血管闭塞的急性卒中血管内治疗的安全性和有效性研究，No.KC21234） |
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| 中文摘要: |
| 目的：探讨替奈普酶与阿替普酶在大血管闭塞急性缺血性卒中(Large Vessel Occlusion，AIS-LVO)患者桥接治疗中的疗效及安全性。方法：回顾性收集2022年9月至2024年9月在徐州市中心医院接受桥接治疗的AIS-LVO患者的基线数据和临床资料，根据静脉溶栓药的不同，分为两组，替奈普酶组（n=49）与阿替普酶组（n=55）。统计分析两组患者的基线数据、主要及次要疗效指标、安全性指标。主要疗效指标指90d的改良Rankin量表（modified Rankin scale，mRS）评分（mRS≤2分为预后良好，mRS＞2分为预后不良），次要疗效指标指术后血管再灌注率、早期神经功能改善发生率。安全性指标包括90d死亡率、症状性颅内出血发生率、任何部位出血发生率。根据90d mRS评分的不同，分为预后良好组和预后不良组，采用单因素和多因素logistic回归分析筛选影响AIS-LVO患者桥接治疗预后的因素。结果：两组患者的术后血管再灌注率、早期神经功能改善发生率、90d死亡率、症状性颅内出血发生率及任何部位出血发生率差异均无统计学意义（均P＞0.05）。替奈普酶组患者的90d预后良好发生率高于阿替普酶组（P＜0.05）。高入院NIHSS评分是AIS-LVO患者桥接治疗预后不良的独立危险因素，替奈普酶降低其预后不良的风险。结论：在接受桥接治疗的AIS-LVO患者中，取栓前使用替奈普酶与更好的功能预后相关。 |
| 英文摘要: |
| Objective: To explore the efficacy and safety of tenecteplase and alteplase in bridging therapy for acute ischemic stroke patients with large vessel occlusion(AIS-LVO). Methods: Baseline data and clinical data of AIS-LVO patients who underwent bridging treatment in Xuzhou Central Hospital from September 2022 to September 2024 were retrospectively collected. They were divided into two groups based on the difference of intravenous thrombolytic drugs, the tenecteplase group (n=49) and the alteplase group (n=55). The baseline data, primary and secondary efficacy indicators, and safety indicators of the two groups were statistically analyzed. The primary efficacy indicator referred to the 90 days modified Rankin scale (mRS) score (mRS≤2 was good prognosis, mRS>2 was bad prognosis), and the secondary efficacy indicator referred to the postoperative vascular reperfusion rate and the incidence of early neurological function improvement. Safety indicator included 90 days mortality, incidence of symptomatic intracranial hemorrhage, and incidence of hemorrhage from any site. According to the difference of 90d mRS scores, they were divided into good prognosis and poor prognosis groups, and the factors affecting the prognosis of bridging treatment in AIS-LVO patients were screened by using univariate and multivariate logistic regression analyses. Results: The successful reperfusion rate, incidence of early neurological function improvement, 90 days mortality rate, symptomatic intracranial hemorrhage, and hemorrhage from any site were not significantly different between the two groups (all P>0.05). The incidence of good 90 days prognosis of patients in the tenecteplase group was higher than that in the alteplase group (P<0.05). High NIHSS scores on upon admission was an independent risk factor for poor prognosis in AIS-LVO patients, tenecteplase reduces the risk of poor prognosis. Conclusions: The use of tenecteplase before thrombolysis is associated with a better functional prognosis in AIS-LVO patients with bridging. |
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