目的 探讨治疗急性脑梗死采用血府逐瘀胶囊与重组人TNK组织型纤溶酶原激活剂联合治疗的临床疗效。方法 选取2022年7月—2024年12月天津市中医药研究院附属医院收治的急性脑梗死90例患者，随机数字法分为对照组45例和治疗组45例。对照组给予重组人TNK组织型纤溶酶原激活剂静脉推注，0.25 mg/kg，在5～10 s内完成。在对照组基础上，治疗组口服血府逐瘀胶囊，6粒/次，每日2次。两组均治疗2周。观察两组患者疗效，对比两组的纤维蛋白原（FIB）、D-二聚体（D-D）、活化部分凝血活酶时间（APTT）、C反应蛋白（CRP）水平，日常活动指数量表（Barthel）评分、白细胞介素-8（IL-8）水平、Fugl-Meyer运动量表（FMA）评分、白细胞介素-6（IL-6）水平、美国国立卫生研宄院卒中量表（NIHSS）评分、肿瘤坏死因子-α（TNF-α）水平。结果 治疗后，治疗组总有效率95.56%，明显高于对照组（80.00%，P＜0.05）。治疗后，两组FIB、D-D、TNF-α、IL-6、IL-8、CRP水平比治疗前降低，而APTT水平升高（P＜0.05），且与对照组相比，治疗后治疗组凝血功能和炎性因子水平好于对照组（P＜0.05）。治疗后，两组Barthel和FMA评分比治疗前升高，而NIHSS评分降低（P＜0.05），且与对照组对比，治疗后治疗组患者评分优于对照组（P＜0.05）。结论 重组人TNK组织型纤溶酶原激活剂与血府逐瘀胶囊协同治疗效果佳，对脑卒中症状具有明显改善作用，脑神经及肢体运动恢复显著，患者生活质量明显提升。

Objective The effect of Xuefu Zhuyu Capsules combined with recombinant human TNK tissue-type plasminogen activator in treatment of acute cerebral infarction. Methods Patients (90 cases) with acute cerebral infarction in Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from July 2022 to December 2024 were randomly divided into control (45 cases) and treatment (45 cases). Patient in were iv administered with Recombinant Human TNK Tissue-type Plasminogen Activator for injection for 5～10s, 0.25 mg/kg, the max dose was 25 mg. Patient in the treatment were po administered with Xuefu Zhuyu Capsules on the basis of the control, 6 grains/time, twice daily. Patient in two were treated for 2 weeks. After treatment, and the coagulation function FIB, D-D and APTT levels, the scores of Barthel, FMA and NIHSS, the levels of TNF-α, IL-6, IL-8 and CRP in two before. Results After treatment, the total effective rate of the treatment group was 95.56%, significantly higher than that of the control group (80.00%, P < 0.05). After treatment, the levels of FIB, D-D, TNF-α, IL-6, IL-8 and CRP in both groups decreased compared with those before treatment, while the level of APTT increased (P < 0.05). Moreover, compared with the control group, the coagulation function and inflammatory factor levels in the treatment group were better than those in the control group after treatment (P < 0.05). After treatment, the Barthel and FMA scores of both groups increased compared with those before treatment, while the NIHSS score decreased (P < 0.05). Moreover, compared with the control group, the score of the treatment group was better than that of the control group after treatment (P < 0.05). Conclusion The synergistic treatment effect of recombinant human TNK tissue-type plasminogen activator and Xuefu Zhuyu Capsules is excellent, which can significantly improve stroke symptoms, significantly recover cerebral nerves and limb movements, and significantly improve the patient′s quality of life.

R971

天津市自然科学基金（19JCYBJC26100）