目的 探讨血管内治疗前阿替普酶静脉溶栓对急性缺血性脑卒中（AIS）患者5-羟色胺（5-HT）/ 5-羟吲哚乙酸（5-HIAA）、3，4-二羟基苯乙酸（DOPAC）/高香草酸（HVA）、脑源性神经营养因子（BDNF）、神经生长因子（NGF）水平的影响。 方法 以随机数字表法将2023年1月至2025年6月医院收治的174例AIS患者分为对照组、研究组，各87例。对照组给予单纯血管内治疗，研究组在血管内治疗前先接受注射用阿替普酶静脉溶栓，随后接受血管内治疗，两组治疗后均观察3个月。比较两组疗效、神经功能缺损程度、认知功能、日常生活活动能力、脑血流动力学、炎症相关指标、血清5-HT/5-HIAA、DOPAC/HVA、BDNF、NGF水平及安全性。 结果 与对照组比，研究组治疗后3个月的总有效率更高（P < 0.05）。与治疗前比，两组治疗后3个月的美国国立卫生研究院卒中量表（NIHSS）评分及血清脂蛋白相关磷脂酶A2（Lp-PLA2）、基质金属蛋白酶-9（MMP-9）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）水平降低，研究组更低；两组简易精神状态检查量表（MMSE）、改良Barthel指数（MBI）评分、大脑中动脉收缩期峰值流速（PSV）、舒张末期血流速度（EDV）、平均血流速度（Vm）及血清5-HT/5-HIAA、DOPAC/HVA、BDNF、NGF水平升高，研究组更高（均P < 0.05）。两组安全性对比差异无统计学意义（P > 0.05）。 结论 血管内治疗前应用阿替普酶静脉溶栓能够有效提高AIS患者疗效，改善神经功能缺损程度、认知功能、日常生活活动能力及脑血流动力学，抑制炎症反应，调节代谢平衡，且未明显增加并发症风险，安全性良好。

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.