Efficacy and prognosis of acute cerebral infarction treated with acute thrombolysis using alteplase and recombinant human tissue type plasminogen activator under emergency green channel: a comparative study

doi:10.3877/cma.j.issn.2095-9133.2026.01.005

Abstract

Abstract:

Objective

To compare the efficacy and prognosis of recombinant tissue plasminogen activator (rt-PA) and Recombinant Human Tissue-Type Plasminogen Activator (TNK) for the treatment of acute cerebral infarction (AIS).

Methods

A retrospective analysis was conducted on the medical records of 103 patients with AIS who were admitted to Yangzhong People's Hospital in Jiangsu Province from January 2024 to December 2024, among them, 65 were male and 38 were female; the age ranged from 42 to 85 years, with an average of (68.19±5.78) years, and they were divided into rt-PA group (51 cases) and TNK group (52 cases) According to different treatment methods. The time from admission to thrombolysis completion, clinical efficacy, National Institutes of Health Stroke Scale (NIHSS) score, complications, modified Rankin Scale (mRS) score and the good prognosis rate at 90 days were compared between the two patient groups.

Result

The time from admission to thrombolysis completion in the TNK group was shorter than that in the rt-PA group (P<0.05). The total effective rate of the TNK group was higher than that of the rt-PA group (P<0.05). The NIHSS scores of both patient groups decreased 24 hours after thrombolysis and 14 days after treatment, and the TNK group was lower than the rt-PA group (P<0.05). The coagulation function indicators of both patient groups increased 24 hours after thrombolysis, but the TNKgroup was lower than the rt-PA group (P<0.05). There was no difference in the total incidence of complications between the two patient groups (P>0.05). The mRS Scores of both groups 1 day before discharge and 90 days after thrombolysis were lower than those before thrombolysis, but there was no difference between the groups (P>0.05), and there was no difference in the good prognosis rate between the two patient groups (P>0.05).

Conclusion

rt-PA and TNK are both effective drugs for AIS thrombolysis under emergency green channel, with similar prognoses, but TNK has advantages in convenient administration and improving short-term efficacy, and clinical selection should be flexible.

Key words: Acute cerebral infarction, Emergency, Recombinant tissue plasminogen activator, Recombinant human tissue plasminogen activator, Thrombolysis, Prognosis

Xianglin Guo, Hu Yan. Efficacy and prognosis of acute cerebral infarction treated with acute thrombolysis using alteplase and recombinant human tissue type plasminogen activator under emergency green channel: a comparative study[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2026, 12(01): 21-25.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2026.01.005

https://zhwsyjdzzz.cma-cmc.com.cn/EN/Y2026/V12/I01/21

Figures/Tables 5

References 14

[1]	Knapen RRMM, Frol S, van Kuijk SMJ, et al. Intravenous thrombolysis for ischemic stroke in the posterior circulation: a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2024, 33(5): 107641.
[2]	迟元卉,李桂茹,陈淑良,等.阿替普酶改善缺血性脑卒中患者神经功能的有效性和安全性研究[J].实用药物与临床, 2024, 27(9): 661-667.
[3]	孙青,周小燕.发病3小时内阿替普酶溶栓可改善急性脑梗死患者的预后[J].内科急危重症杂志, 2024, 30(6): 550-553.
[4]	Bivard A, Garcia-Esperon C, Churilov L, et al. Tenecteplase versus alteplase for stroke thrombolysis evaluation (TASTE): a multicentre, prospective, randomized, open-label, blinded-endpoint, controlled phase III non-inferiority trial protocol[J]. Int J Stroke, 2023, 18(6): 751-756.
[5]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性卒中诊治指南2023[J].中华神经科杂志, 2024, 57(6): 523-559.
[6]	Villalobos E, Barnes S R, Qureshi I A, et al. Spanish version of the national institutes of health stroke scale: awareness and use in United States. a survey study[J]. J Vasc Interv Neurol, 2017, 9(3): 1-6.
[7]	张世洪,吴波,谈颂.卒中登记研究中Barthel指数和改良的Rankin量表的适用性与相关性研究[J].中国循证医学杂志, 2004, 4(12): 871-874.
[8]	Gonçalves OR, Ferreira MY, de Almeida Monteiro G, et al. Intravenous thrombolysis with tenecteplase versus alteplase in acute ischemic stroke tandem occlusions: a systematic review and meta-analysis of current available literature[J]. J Thromb Thrombolysis, 2025, 58(3): 411-419.
[9]	赵丽姣,杨松海,陈善鹏,等.老年急性脑梗死患者阿替普酶静脉溶栓后疗效观察及相关因素分析[J].脑与神经疾病杂志, 2023, 31(3): 180-185.
[10]	Marè A, Lorenzut S, Janes F, et al. Comparison of pharmacokinetic properties of alteplase and tenecteplase. The future of thrombolysis in acute ischemic stroke[J]. Expert Opin Drug Metab Toxicol, 2024, 20(1/2): 25-36.
[11]	Muir KW, Ford GA, Ford I, et al. Tenecteplase versus alteplase for acute stroke within 4·5 h of onset (ATTEST-2): a randomised, parallel group, open-label trial[J]. Lancet Neurol, 2024, 23(11): 1087-1096.
[12]	Bala, Singh N, Buck B, et al. Safety and efficacy of tenecteplase compared with alteplase in patients with large vessel occlusion stroke: a prespecified secondary analysis of the ACT randomized clinical trial[J]. JAMA Neurol, 2023, 80(8): 824-832.
[13]	Abuelazm M, Seri AR, Awad AK, et al. The efficacy and safety of tenecteplase versus alteplase for acute ischemic stroke: an updated systematic review, pairwise, and network meta-analysis of randomized controlled trials[J]. J Thromb Thrombolysis, 2023, 55(2): 322-338.
[14]	Warach S J, Ranta, Kim J, et al. Symptomatic intracranial hemorrhage with tenecteplase vs alteplase inpatients with acute ischemic stroke: the comparative effectiveness of routine tenecteplase vs alteplase in acute ischemic stroke (CERTAIN) collaboration[J]. JAMA Neurol, 2023, 80(7): 732-738.

组别	例数	性别[例（%）]		年龄（岁）	体重指数（kg/m²）	发病至就诊时间（h）	随机血糖（mmol/L）	溶栓前收缩压（mmHg）
组别	例数	男性	女性	年龄（岁）	体重指数（kg/m²）	发病至就诊时间（h）	随机血糖（mmol/L）	溶栓前收缩压（mmHg）
rt-PA组	51	33（64.71）	18（35.29）	68.04±5.71	23.61±2.01	1.92±0.22	7.56±0.99	148.75±6.45
TNK组	52	32（61.54）	20（38.46）	68.34±5.85	23.17±2.30	1.91±0.25	7.74±0.87	150.04±6.03
t/χ²值		0.11		0.26	1.03	0.22	0.98	1.05
P值		>0.05		>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	脑梗死部位[例（%）]			合并症[例（%）]
组别	例数	大脑中动脉	后循环	前循环	糖尿病	高血脂	高血压
rt-PA组	51	33（64.71）	7（13.72）	11（21.57）	18（35.29）	14（27.45）	35（68.63）
TNK组	52	35（67.31）	9（17.31）	8（15.38）	22（42.31）	17（32.69）	30（57.69）
t/χ²值		0.77			0.53	0.34	1.32
P值		>0.05			>0.05	>0.05	>0.05

组别	例数	性别[例（%）]		年龄（岁）	体重指数（kg/m²）	发病至就诊时间（h）	随机血糖（mmol/L）	溶栓前收缩压（mmHg）
组别	例数	男性	女性	年龄（岁）	体重指数（kg/m²）	发病至就诊时间（h）	随机血糖（mmol/L）	溶栓前收缩压（mmHg）
rt-PA组	51	33（64.71）	18（35.29）	68.04±5.71	23.61±2.01	1.92±0.22	7.56±0.99	148.75±6.45
TNK组	52	32（61.54）	20（38.46）	68.34±5.85	23.17±2.30	1.91±0.25	7.74±0.87	150.04±6.03
t/χ²值		0.11		0.26	1.03	0.22	0.98	1.05
P值		>0.05		>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	脑梗死部位[例（%）]			合并症[例（%）]
组别	例数	大脑中动脉	后循环	前循环	糖尿病	高血脂	高血压
rt-PA组	51	33（64.71）	7（13.72）	11（21.57）	18（35.29）	14（27.45）	35（68.63）
TNK组	52	35（67.31）	9（17.31）	8（15.38）	22（42.31）	17（32.69）	30（57.69）
t/χ²值		0.77			0.53	0.34	1.32
P值		>0.05			>0.05	>0.05	>0.05

组别	例数	显效	有效	无效	总有效率
rt-PA组	51	23（45.10）	19（37.25）	9（17.65）	42（82.35）
TNK组	52	28（53.84）	22（42.31）	2（3.85）	50（96.15）
χ²值					5.14
P值					<0.05

组别	例数	显效	有效	无效	总有效率
rt-PA组	51	23（45.10）	19（37.25）	9（17.65）	42（82.35）
TNK组	52	28（53.84）	22（42.31）	2（3.85）	50（96.15）
χ²值					5.14
P值					<0.05

组别	例数	溶栓前	溶栓24 h后	治疗14 d后	F值	P值
rt-PA组	51	12.75±2.04	10.44±1.25^a	4.34±0.85^ab	11.01	<0.05
TNK组	52	12.97±2.30	9.81±1.02^a	3.98±0.78^abc	11.01	<0.05
F值			9.04
P值			<0.05

Please choose a citation manager

Content to export