目的 探讨依洛尤单抗联合阿替普酶治疗大动脉粥样硬化性、Fazekas量表评分为重度的急性脑梗死患者的临床疗效。方法 选取2021年1月—2022年11月天津市北辰医院脑神经科收治的112例大动脉粥样硬化性、Fazekas量表评分为重度的急性脑梗死患者，按随机数字表法将所有患者分为对照组和治疗组，每组各56例。对照组患者给予注射用阿替普酶，按照0.9 mg/kg计算，最高剂量不超过90 mg，总剂量的10%静脉慢推1 min，其余90%药物静脉点滴1 h。治疗组在对照组的基础上皮下给药依洛尤单抗注射液，140 mg/次，1次/2周。两组治疗2周。观察两组的临床疗效和症状缓解时间，比较两组治疗前后血脂指标和血清细胞因子的变化情况。结果 治疗后，治疗组患者总有效率是92.86%，显著高于对照组的80.36%（P＜0.05）。治疗后，治疗组偏侧肢体无力、口角歪斜、吞咽异常、偏侧肢体麻木缓解时间均显著短于对照组（P＜0.05）。治疗后，两组总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）水平均较同组治疗前显著降低，而高密度脂蛋白（HDL-C）水平显著升高（P＜0.05）；治疗后，治疗组血脂水平改善优于对照组（P＜0.05）。治疗后，两组神经损伤100β蛋白（S100β）、血清细胞间黏附因子-1（ICAM-1）、神经元特异性烯醇化酶（NSE）、肿瘤坏死因子α（TNF-α）水平均低于同组治疗前（P＜0.05）；且治疗后，治疗组S100β、ICAM-1、NSE、TNF-α水平低于对照组（P＜0.05）。结论 依洛尤单抗联合阿替普酶治疗大动脉粥样硬化性、Fazekas量表评分为重度的急性脑梗死具有较好的临床疗效，可加快缓解患者的临床症状，并可有效调节患者血脂水平，降低机体炎症反应，值得借鉴应用。

Objective To explore the clinical study of evolocumab combined with alteplase in treatment of severe acute cerebral infarction with large atherosclerosis and Fazekas. Methods A total of 112 patients with severe acute cerebral infarction with large atherosclerosis and Fazekas scale were selected from the Department of Brain and Neurology of Tianjin Beichen Hospital from January 2021 to November 2022. All patients were divided into control group and treatment group according to random number table method, with 56 cases in each group. Patients in control group were given Alteplase for injection, calculated according to 0.9 mg/kg, the highest dosage should not exceed 90 mg, 10% of the total dosage should be slowly pushed intravenously for 1 min, and the remaining 90% should be intravenous dribbled for 1 h. Patients in the control group were sc administered Evolocumab Injection on the basis of the control group, 140 mg/time, once 2 weeks. Both groups were treated for 2 weeks. The clinical efficacy and symptom remission time of the two groups were observed, and the changes of lipid indexes and serum cytokines before and after treatment were compared between two groups. Results After treatment, the total effective rate of the treatment group was 92.86%, which was significantly higher than that of control group (80.36%, P＜0.05). After treatment, the relief time of hemilimb weakness, mouth skew, swallowing abnormality and hemilimb numbness in the treatment group were significantly shorter than those in control group (P＜0.05). After treatment, the levels of total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL-C) in two groups weresignificantly decreased compared with before treatment, but the level of high density lipoprotein (HDL-C) was significantly increased (P＜ 0.05). After treatment, the blood lipid level in treatment group was better than that in control group (P＜0.05). After treatment, the levels of nerve injury 100β protein (S100β), serum intercellular adhesion factor (ICAM-1), neuron-specific enolase (NSE) and tumor necrosis factor α (TNF-α) in two groups were lower than before treatment (P＜0.05). After treatment, the levels of S100β, ICAM-1, NSE and TNF-α in treatment group were lower than those in control group (P＜ 0.05). Conclusion Evolocumab combined with alteplase has a good clinical effect in treatment of severe acute cerebral infarction with large atherosclerosis and Fazekas scale, and can accelerate the relief of clinical symptoms of patients, and can effectively regulate the blood lipid level of patients, reduce the inflammatory response of the body, which is worthy of reference.

R971

天津市北辰区科技计划项目（SHGY-2020005）