Abstract: Objective To investigate the effect of mechanical thrombectomy after intravenous thrombolysis with arteprase (rt-PA) on patients with atherosclerotic cerebral infarction. Methods　One hundred and thirty-two patients with atherosclerotic cerebral infarction admitted to Third People's Hospital of Liaocheng City from August 2019 to August 2021 were selected as the research objects. The patients were divided into a control group and an observation group by the random number table method, with 66 cases in each group. There were 34 males and 32 females in the control group, and they were 44-69 (56.51±6.27) years old. There were 35 males and 31 females in the observation group, and they were 42-68 (55.01±6.11) years old. The control group took intravenous thrombolysis with rt-PA, and the observation group took mechanical thrombectomy after intravenous thrombolysis with rt-PA. The clinical efficacies, scores of modified Rankin Scale (MRS) and National Institutes of Health Stroke Scale (NIHSS), and levels of serum brain-derived neurotrophic factor (BDNF), S100B protein (S100b), neurotrophic factor (NTF), neuron specific enolase (NSE), serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-17 (IL-17), high-sensitivity C-reactive protein (hs-CRP), serum adropin protein (Adropin), apolipoprotein A1 (ApoA1), and oxyphosphorylase-1 (PON-1) before and after the treatment were compared between the two groups. t and χ² tests were applied. Results　The total clinical effective rate was 92.42% (61/66) in the observation group, and was 80.30% (53/66) in the control group, with a statistical difference between these two groups (χ²=4.117, P=0.043). One week after the treatment, the scores of NIHSS and mRS were (8.74±2.13) and (2.01±0.13) in the observation group, and were (13.69±3.24) and (2.63±0.27) in the control group, with statistical differences between these two groups (t=10.371 and 16.808; both P<0.001). One week after the treatment, the levels of S100B, NSE, BDNF, NTF, hsCRP, IL-6, and TNF-α, IL-17, Adropin, ApoA1, and PON-1 were (0.21±0.04) μg/L, (7.24±1.38) μg/L, (4.11±0.43) μg/L, (5.78±0.66) μg/L, (4.87±0.82) mg/L, (9.14±2.03) pg/ml, (2.74±0.68) μg/L, (12.74±3.27) pg/ml, (3.87±0.41) μg/ml, (1.78±0.27) g/L, and (219.74±28.4) U/L in the observation group, and were (0.29±0.03) μg/L, (9.65±2.11) μg/L, (3.42±0.39) μg/L, (4.39±0.61) μg/L, (7.64±0.91) mg/L, (16.57±3.38) pg/ml, (3.55±0.72) μg/L, (20.85±3.86) pg/ml, (3.22±0.39) μg/ml, (1.49±0.24) g/L, and (177.46±21.57) U/L in the control group, with statistical differences between these two groups (t=8.124, 7.766, 9.656, 12.565, 18.371, 15.310, 6.645, 12.462, 9.332, 6.522, and 9.625; all P<0.001). Conclusion　Intravenous thrombolysis with rt-PA combined with mechanical thrombectomy is effective in the treatment of patients with atherosclerotic cerebral infarction, and can effectively reduce the inflammatory reaction, improve  the neurological function, and promote the recovery.

Key words: Alteplase, Intravenous thrombolysis, Atherosclerosis, Cerebral , infarction

摘要： 目的　探讨阿替普酶（rt-PA）静脉溶栓后机械取栓对动脉粥样硬化性脑梗死患者的影响。方法　选取2019年8月至2021年8月聊城市第三人民医院收治的132例动脉粥样硬化性脑梗死患者为研究对象，采用随机数字表法将患者分为对照组和观察组，每组66例。对照组男34例，女32例，年龄44～69（56.51±6.27）岁；观察组男35例，女31例，年龄42～68（55.01±6.11）岁。对照组采用rt-PA静脉溶栓治疗，观察组采用rt-PA静脉溶栓后机械取栓治疗。比较两组临床疗效，治疗前后改良的Rankin量表（mRS）、美国国立卫生研究院卒中量表（NIHSS）评分、血清脑源性神经营养因子（BDNF）、S100B蛋白（S100B）、神经营养因子（NTF）、神经元特异性烯醇化酶（NSE）、血清肿瘤坏死因子（TNF-α）、白细胞介素（IL）-6、IL-17、高敏C-反应蛋白（hs-CRP）、血清Adropin蛋白（Adropin）、载脂蛋白A1（ApoA1）、氧磷酶1（PON-1）水平。采用t检验、χ²检验进行统计学分析。结果　观察组临床总有效率为92.42%（61/66），高于对照组的80.30%（53/66），两组比较，差异有统计学意义（χ²=4.117，P=0.043）。治疗1周后，观察组NIHSS评分为（8.74±2.13）分、mRS为（2.01±0.13）分，均低于对照组的（13.69±3.24）分、（2.63±0.27）分，两组比较，差异均有统计学意义（t=10.371、16.808，均P<0.001）；治疗1周后，观察组患者血清S100B为（0.21±0.04）μg/L、NSE为（7.24±1.38）μg/L，均低于对照组的（0.29±0.03）μg/L、（9.65±2.11）μg/L，血清BDNF为（4.11±0.43）μg/L、NTF为（5.78±0.66）μg/L，均高于对照组的（3.42±0.39）μg/L、（4.39±0.61）μg/L，两组比较，差异均有统计学意义（t=8.124、7.766、9.656、12.565，均P<0.001）；治疗1周后，观察组患者血清hs-CRP为（4.87±0.82）mg/L、IL-6为（9.14±2.03）pg/ml、TNF-α为（2.74±0.68）μg/L、IL-17为（12.74±3.27）pg/ml，均低于对照组的（7.64±0.91）mg/L、（16.57±3.38）pg/ml、（3.55±0.72）μg/L、（20.85±3.86）pg/ml，两组比较，差异均有统计学意义（t=18.371、15.310、6.645、12.462，均P<0.001）；治疗1周后，观察组患者血清Adropin为（3.87±0.41）μg/ml、ApoA1为（1.78±0.27）g/L、PON-1为（219.74±28.4）U/L，均高于对照组的（3.22±0.39）μg/ml、（1.49±0.24）g/L、（177.46±21.57）U/L，两组比较，差异均有统计学意义（t=9.332、6.522、9.625，均P<0.001）。结论　rt-PA静脉溶栓后联合机械取栓治疗动脉粥样硬化性脑梗死患者效果显著，能有效减轻炎性反应，改善神经功能，促进病情恢复。

关键词: 阿替普酶, 静脉溶栓, 动脉粥样硬化, 脑梗死