血管内治疗前阿替普酶静脉溶栓对急性缺血性脑卒中患者5-HT/5-HIAA、DOPAC/HVA、BDNF、NGF水平的影响

doi:10.3969/j.issn.1006-5725.2026.12.017

Abstract

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

CLC Number:

R743

Wenhao SUN,Guangming YAO,Liang LI,Miao YU,Guang WANG,Jiwei ZHANG. The effect of intravenous thrombolysis with alteplase on the levels of 5-HT/5-HIAA， DOPAC/HVA， BDNF and NGF in patients with acute ischemic stroke before endovascular treatment[J]. The Journal of Practical Medicine, 2026, 42(12): 2216-2222.

Figures/Tables 7

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References 26

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项目	对照组（n = 87）	研究组（n = 87）	χ² /t值	P值
性别/［例（%）］
男	45（51.72）	47（54.02）	0.092	0.761
女	42（48.28）	40（45.98）
年龄（x ± s）/岁	58.44 ± 6.15	59.78 ± 6.22	1.429	0.155
发病至入院接受治疗时间（x ± s）/h	3.09 ± 0.38	3.12 ± 0.45	0.475	0.635
体质量指数（x ± s）/（kg/m²）	23.37 ± 1.15	23.41 ± 1.19	0.225	0.822
闭塞部位/［例（%）］
颈内动脉	26（29.89）	24（27.59）	0.120	0.942
大脑中动脉M1段	44（50.57）	45（51.72）
大脑中动脉M2段	17（19.54）	18（20.69）

疗效	对照组（n = 87）	研究组（n = 87）	χ² 值	P值
总有效率	70（80.46）	80（91.95）	4.833	0.028
基本痊愈	33（37.93）	37（42.53）
显著进步	19（21.84）	23（26.44）
进步	18（20.69）	20（22.99）
无效	17（19.54）	7（8.05）

项目	对照组（n = 87）	研究组（n = 87）	t值	P值
NIHSS
治疗前	16.89 ± 2.77	17.23 ± 3.34	0.731	0.466
治疗后3个月	8.94 ± 2.15^*	6.69 ± 1.68^*	7.692	< 0.001
MMSE
治疗前	23.74 ± 1.90	23.67 ± 1.88	0.244	0.807
治疗后3个月	25.51 ± 1.10^*	26.03 ± 1.15^*	3.048	0.003
MBI
治疗前	59.02 ± 3.52	58.76 ± 3.44	0.493	0.623
治疗后3个月	75.42 ± 4.26^*	79.34 ± 5.33^*	5.359	< 0.001

项目	对照组（n=87）	研究组（n=87）	t值	P值
PSV
治疗前	80.22 ± 9.09	79.67 ± 8.82	0.405	0.686
治疗后3个月	104.93 ± 10.77^*	110.34 ± 13.45^*	2.929	0.004
EDV
治疗前	25.12 ± 3.57	24.94 ± 3.45	0.338	0.736
治疗后3个月	33.61 ± 5.03^*	38.54 ± 6.71^*	5.483	< 0.001
Vm
治疗前	48.15 ± 6.01	47.22 ± 5.58	1.058	0.292
治疗后3个月	62.13 ± 6.21^*	66.54 ± 7.78^*	4.132	< 0.001

项目	对照组（n = 87）	研究组（n = 87）	t值	P值
Lp-PLA2/（ng/mL）
治疗前	272.38 ± 35.22	275.45 ± 37.94	0.553	0.581
治疗后3个月	202.33 ± 20.41^*	179.76 ± 25.88^*	6.387	< 0.001
MMP-9/（ng/mL）
治疗前	311.89 ± 39.78	313.56 ± 42.56	0.267	0.789
治疗后3个月	221.79 ± 31.25^*	209.77 ± 26.55^*	2.734	0.007
hs-CRP/（mg/L）
治疗前	15.84 ± 1.25	16.05 ± 2.33	0.741	0.460
治疗后3个月	8.39 ± 1.95^*	7.61 ± 1.56^*	2.913	0.004
TNF-α/（pg/mL）
治疗前	44.94 ± 6.69	45.21 ± 7.78	0.245	0.806
治疗后3个月	25.82 ± 5.07^*	23.56 ± 4.23^*	3.193	0.002

The effect of intravenous thrombolysis with alteplase on the levels of 5-HT/5-HIAA， DOPAC/HVA， BDNF and NGF in patients with acute ischemic stroke before endovascular treatment

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项目	对照组（n = 87）	研究组（n = 87）	t值	P值
5-HT/5-HIAA
治疗前	1.15 ± 0.36	1.13 ± 0.34	0.377	0.707
治疗后3个月	1.41 ± 0.40^*	1.69 ± 0.51^*	4.029	< 0.001
DOPAC/HVA
治疗前	0.75 ± 0.22	0.72 ± 0.13	1.095	0.275
治疗后3个月	1.14 ± 0.35^*	1.45 ± 0.41^*	5.346	< 0.001
BDNF/（ng/mL）
治疗前	18.09 ± 3.34	17.83 ± 3.21	0.524	0.601
治疗后3个月	22.19 ± 4.47^*	24.32 ± 5.54^*	2.791	0.006
NGF/（pg/mL）
治疗前	181.23 ± 25.44	179.87 ± 26.78	0.343	0.732
治疗后3个月	221.76 ± 33.12^*	238.89 ± 37.68^*	3.185	0.002

安全性	对照组（n = 87）	研究组（n = 87）	χ² 值	P值
总并发症发生率	4（4.60）	5（5.75）	0.117	0.732
消化道出血	2（2.30）	3（3.45）
有症状性颅内出血	0（0.00）	1（1.15）
无症状性颅内出血	1（1.15）	1（1.15）
脑疝	1（1.15）	0（0.00）

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