Curative effect of different thrombolytic regimens on patients with ultra-early acute cerebral infarction of different characteristics

doi:10.11958/20250926

Abstract

Abstract:

Objective To explore curative effect of two thrombolytic regimens in the treatment of ultra-early acute cerebral infarction (ACI) of different age groups and different thrombolytic time windows. Methods A total of 166 patients with ACI were enrolled, with interval from onset to treatment ≤4.5 h. According to different thrombolytic regiments, patients were divided into the recombinant tissue plasminogen activator (rt-PA) group (104 cases, intravenous thrombolysis with 0.9 mg/kg rt-PA) and the tenecteplase (TNK) group (62 cases, intravenous thrombolysis with 0.25 mg/kg TNK). According to different age groups and different thrombolytic time windows, patients were divided into the high age group (≥70 years), the low age group (< 70 years), the short time window group (< 3 h) and the long time window group (3-4.5 h). After thrombolysis, laboratory indexes [neutrophil (NEU), lymphocyte (LYM)], scores of National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and incidence of adverse events were compared in different groups by factorial analysis method. Results There was no significant difference in any index between the rt-PA group and the TNK group (P>0.05). Compared with the high age group at 7 d after thrombolysis, NIHSS score, NEU, neutrophil to lymphocyte ratio (NLR) and high sensitive C-reactive protein (hs-CRP) were lower, while LYM and albumin (ALB) were higher in the low age group (P<0.05). Compared with the long time window group, NEU and NLR were lower, while LYM was higher in the short time window group (P<0.05). There was no significant difference in total incidence of adverse events within 14 d of thrombolysis between the different age groups and the different thrombolytic time window groups (P>0.05). Conclusion For patients with ultra-early ACI, 0.9 mg/kg rt-PA and 0.25 mg/kg TNK have comparable efficacy in intravenous thrombolysis, and both have better effects when patient age is<70 years old and the thrombolysis time window is<3 hours.

Key words: cerebral infarction, acute disease, fibrinolytic agents, age factors, time factors, root cause analysis, recombinant tissue plasminogen activator, tenecteplase

CLC Number:

R743.3

Figures/Tables 7

References 24

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组别		n	年龄/岁		男性		高血压	房颤
rt-PA组		104	69.26±10.62		72（69.2）		63（60.6）	15（14.4）
TNK组		62	68.56±10.70		41（66.1）		42（67.7）	9（14.5）
t、χ²或Z			0.407		0.172		0.858	0.000
组别	糖尿病			吸烟	饮酒	溶栓前NIHSS评分/分
rt-PA组	24（23.1）			42（40.4）	11（10.6）	4.00（3.00，7.00）
TNK组	20（32.3）			28（45.2）	9（14.5）	4.00（2.00，10.25）
t、χ²或Z	1.681			0.363	0.569	0.634

组别		n	年龄/岁		男性		高血压	房颤
rt-PA组		104	69.26±10.62		72（69.2）		63（60.6）	15（14.4）
TNK组		62	68.56±10.70		41（66.1）		42（67.7）	9（14.5）
t、χ²或Z			0.407		0.172		0.858	0.000
组别	糖尿病			吸烟	饮酒	溶栓前NIHSS评分/分
rt-PA组	24（23.1）			42（40.4）	11（10.6）	4.00（3.00，7.00）
TNK组	20（32.3）			28（45.2）	9（14.5）	4.00（2.00，10.25）
t、χ²或Z	1.681			0.363	0.569	0.634

组别	n	NIHSS评分	mRS评分
rt-PA低龄组	50	1.00（0.00，2.00）	0.00（0.00，2.00）
rt-PA高龄组	54	1.00（0.00，5.00）	0.00（0.00，2.00）
TNK低龄组	32	0.00（0.00，2.00）	0.00（0.00，1.00）
TNK高龄组	30	3.50（0.00，8.50）	0.00（0.00，3.00）
H_用药方案		0.962	0.290
H_年龄段		23.626^＊＊	1.951
H_{用药方案*年龄段}		1.071	1.497

组别	n	NIHSS评分	mRS评分
rt-PA低龄组	50	1.00（0.00，2.00）	0.00（0.00，2.00）
rt-PA高龄组	54	1.00（0.00，5.00）	0.00（0.00，2.00）
TNK低龄组	32	0.00（0.00，2.00）	0.00（0.00，1.00）
TNK高龄组	30	3.50（0.00，8.50）	0.00（0.00，3.00）
H_用药方案		0.962	0.290
H_年龄段		23.626^＊＊	1.951
H_{用药方案*年龄段}		1.071	1.497

组别	n	NEU/（×109/L）	LYM/（×109/L）
rt-PA低龄组	50	4.91（3.55，6.36）	1.94（1.47，2.86）
rt-PA高龄组	54	5.14（3.45，6.72）	1.48（0.98，2.21）
TNK低龄组	32	5.00（3.59，5.49）	1.83（1.34，2.70）
TNK高龄组	30	5.83（3.76，7.53）	1.26（0.81，2.05）
H用药方案		1.101	0.530
H年龄段		4.128＊	5.368＊
H用药方案*年龄段		1.976	0.457
组别	NLR	hs-CRP/（mg/L）	ALB/（g/L）
rt-PA低龄组	2.44（1.58， 3.38）	1.50（0.11，4.69）	40.63（38.56，43.01）
rt-PA高龄组	2.95（1.94，5.88）	6.27（1.96，19.99）	35.77（31.36，39.04）
TNK低龄组	2.41（1.65，3.89）	1.41（0.00，6.73）	39.82（36.67，44.94）
TNK高龄组	3.82（2.15，8.85）	8.99（2.99，17.84）	34.45（31.36，37.16）
H_用药方案	1.579	0.020	1.318
H_年龄段	12.198^＊＊	7.587^＊＊	64.179^＊＊
H_{用药方案*年龄段}	0.179	0.010	0.766