关键词: 替奈普酶, 机械取栓, 急性大血管闭塞性卒中, 白细胞介素-6, γ干扰素, 神经功能

Abstract:

Objective To investigate the effects of intravenous thrombolysis using tenecteplase combined with mechanical thrombectomy on serum interleukin-6 （IL-6）， interferon-γ （IFN-γ） levels， and neurological function in patients with acute large vessel occlusive stroke （ALVOS）. Methods A total of 132 patients diagnosed with ALVOS treated at our institution between June 2021 and August 2024 were retrospectively enrolled in this study. Using 1∶1∶1 propensity score matching， the patients were stratified into three groups： group A （n = 44， treated with tenecteplase intravenous thrombolysis combined with mechanical thrombectomy）， group B （n = 44， treated with alteplase intravenous thrombolysis combined with mechanical thrombectomy）， and group C （n = 44， treated with mechanical thrombectomy alone）. We compared serum levels of IL-6 and IFN-γ among the three groups at baseline （before treatment） and at 24 hours， 7 days， and 14 days after treatment. We also evaluated stroke severity and functional outcomes using the National Institutes of Health Stroke Scale （NIHSS）， Modified Rankin Scale （mRS）， and Barthel Index （BI）， and documented rates of vascular recanalization， adverse safety events， and total medical costs. Results The puncture-to-recanalization time was significantly shorter in Group A compared with Groups B and C （P < 0.05）， and no significant difference was observed between Groups B and C （P > 0.05）. At 24 hours， 7 days， and 14 days post-treatment， the mean serum levels of IL-6 and IFN-γ were lower in Group A than in Groups B and C， and lower in Group B than in Group C （all P < 0.05）. At 24 hours， 3 days， 7 days， and 14 days post-treatment， the NIHSS scores were significantly lower in Group A than in Groups B and C （P < 0.05）， with no significant difference detected between Groups B and C （P > 0.05）. No significant between-group differences were identified in the proportion of patients with mRS ≤ 2， mRS score distribution， or all-cause mortality across the three groups （all P > 0.05）. The Barthel Index score was significantly higher in Group A than in Groups B and C （P < 0.05）， while no significant difference was found between Groups B and C （P > 0.05）. No significant difference was observed in the total incidence of adverse events among the three patient groups （P > 0.05）. The cost of thrombolytic drugs was higher in Group A than in Group B， but the total hospitalization cost was significantly lower in Group A compared with Group B （P < 0.05）. No significant difference in total cost was detected between Group A and Group C （P > 0.05）， and the total cost of Group B was significantly higher than that of Group C （P < 0.05）. Conclusions For patients with ALVOS， tenecteplase intravenous thrombolysis combined with mechanical thrombectomy can effectively shorten the puncture-to-recanalization time， reduce serum levels of IL-6 and IFN-γ， promote early neurological function recovery， and does not increase bleeding risk. Moreover， the total medical cost of this combined regimen is comparable to that of mechanical thrombectomy alone， indicating that it delivers favorable clinical benefits and economic advantages.

Key words: tenecteplase, mechanical thrombectomy, acute large vessel occlusive stroke, interleukin-6, interferon gamma, neurological function