关键词: 急性缺血性脑卒中, 阿替普酶, 血管内治疗, 神经功能, 炎症反应

Abstract:

Objective To investigate the effects of intravenous thrombolysis with alteplase prior to endovascular treatment on the levels of 5-hydroxytryptamine （5-HT）/5-hydroxyindoleacetic acid （5-HIAA）， 3，4-dihydroxyphenylacetic acid （DOPAC）/homovanillic acid （HVA）， brain-derived neurotrophic factor （BDNF）， and nerve growth factor （NGF） in patients with acute ischemic stroke （AIS）. Methods A total of 174 AIS patients who were admitted to the hospital from January 2023 to June 2025 were divided into a control group and a study group using the random number table method， with 87 cases in each group. The control group was treated with simple endovascular treatment. The study group received intravenous thrombolysis with alteplase for injection prior to endovascular treatment and then underwent endovascular treatment. Both groups were followed up for 3 months after treatment. The efficacy， degree of neurological deficits， cognitive function， activities of daily living， cerebral hemodynamics， inflammation-related indicators， serum levels of 5-HT/5-HIAA， DOPAC/HVA， BDNF， NGF， and safety were compared between the two groups. Results Compared with the control group， the total effective rate of the study group was significantly higher 3 months after treatment （P < 0.05）. When compared with the pre-treatment values， the scores of the National Institutes of Health Stroke Scale （NIHSS） and the levels of serum lipoprotein-associated phospholipase A2 （Lp-PLA2）， matrix metalloproteinase-9 （MMP-9）， high-sensitivity C-reactive protein （hs-CRP）， and tumor necrosis factor-α （TNF-α） in both groups decreased 3 months after treatment， and the values in the study group were lower. The scores of the Mini-Mental State Examination Scale （MMSE）， Modified Barthel Index （MBI）， peak systolic velocity （PSV）， end-diastolic velocity （EDV）， mean velocity （Vm） of the middle cerebral artery， and the serum levels of 5-HT/5-HIAA， DOPAC/HVA， BDNF， and NGF in both groups increased， and the values in the study group were higher （all P < 0.05）. There was no significant difference in safety between the two groups （P > 0.05）. Conclusion Intravenous thrombolysis with alteplase prior to endovascular treatment can effectively enhance the treatment efficacy for patients with AIS， alleviate the degree of neurological deficit， improve cognitive function， activities of daily living， and cerebral hemodynamics， suppress the inflammatory response， regulate metabolic balance， and does not significantly increase the risk of complications， demonstrating good safety.

Key words: acute ischemic stroke, alteplase, intravascular treatment, neurological function, inflammatory response