四种静脉溶栓药物治疗急性缺血性脑卒中的 研究进展
Research Progress of Four Intravenous Thrombolytic Drugs in the Treatment of Acute Ischemic Stroke
摘要: 急性缺血性脑卒中(acute ischemic stroke, AIS)是全球主要致残原因之一，时间窗内静脉溶栓是目前循证证据最充分的超早期治疗措施。阿替普酶、替奈普酶、瑞替普酶与重组人尿激酶是临床常用的四类静脉溶栓药物，在药理特性、作用机制、再通效率及安全性方面存在显著差异。本文系统梳理四种溶栓药物的作用机制、临床疗效、出血风险，以及在特殊人群(如高龄、轻型卒中、大血管闭塞)的应用特点，并结合近十年来国内外最新临床研究(如TRACE-2、ATTEST-2、TASTE、ORIGINAL、INTRECIS、PROST 系列试验)进行比较评估。本研究旨在为临床制定更精准、分层化的溶栓策略提供依据，并为未来研究方向提供参考。
Abstract: Acute ischemic stroke (AIS) is one of the leading causes of disability worldwide. Intravenous thrombolysis within the therapeutic time window remains the most evidence-based ultra-early treatment. Alteplase, tenecteplase, reteplase, and recombinant human prourokinase are four commonly used intravenous thrombolytic drugs in clinical practice, which exhibit significant differences in pharmacological properties, mechanisms of action, recanalization efficiency, and safety. This article systematically reviews the mechanisms of action, clinical efficacy, bleeding risks, and application characteristics in special populations (such as elderly patients, mild stroke, and large vessel occlusion) of these four thrombolytic drugs. Furthermore, a comparative evaluation is conducted based on the latest clinical studies from both domestic and international sources over the past decade (e.g., TRACE-2, ATTEST-2, TASTE, ORIGINAL, INTRECIS, and PROST series trials). This study aims to provide a basis for developing more precise and stratified thrombolytic strategies in clinical practice and to offer references for future research directions.
文章引用：陶攀, 周长青. 四种静脉溶栓药物治疗急性缺血性脑卒中的 研究进展[J]. 临床医学进展, 2026, 16(5): 2328-2340. https://doi.org/10.12677/acm.2026.1652043

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