目的 探讨逐瘀通脉胶囊与注射用重组人TNK组织型纤溶酶原激活剂治疗急性脑梗死的临床疗效。方法 选取2023年8月—2025年9月邢台市中心医院神经内科收治的110例急性脑梗死患者，按照随机数字法分为对照组和治疗组，每组55例。对照组采用注射用重组人TNK组织型纤溶酶原激活剂，0.9 mg/kg，其中10%药物静脉推注（1 min），余90%药物静脉泵入（1 h）。治疗组在对照组基础上口服逐瘀通脉胶囊，2粒/次，每日3次。两组用药14 d。观察两组的临床疗效，比较两组中医证候积分、改良Barthel指数量表（BI）、美国国立卫生研究院卒中评分量表（NIHSS）评分、生长停滞特异性蛋白6（GAS6）、同型半胱氨酸（Hcy）、脂肪酸结合蛋白4（FABP4）、γ-干扰素（IFN-γ）水平。结果 治疗后，治疗组总有效率是96.36%，显著高于对照组的83.64%（P＜0.05）。治疗后，两组患者半身不遂积分、口舌歪斜积分、言语謇涩积分、肢体麻木积分均低于治疗前（P＜0.05），且与对照组对比，治疗组半身不遂积分、口舌歪斜积分、言语謇涩积分、肢体麻木积分均更低（P＜0.05）。治疗后，两组患者BI评分高于治疗前，而NIHSS评分低治疗前（P＜0.05），且与对照组对比，治疗组BI评分更高，且治疗组NIHSS评分更低（P＜0.05）。治疗后，两组血清GAS6、Hcy、IFN-γ、FABP4水平均低于治疗前（P＜0.05），且与对照组对比，治疗组血清GAS6、Hcy、IFN-γ、FABP4水平更低（P＜0.05）。结论 逐瘀通脉胶囊联合重组人TNK组织型纤溶酶原激活剂在急性脑梗死治疗中展示了良好的疗效，尤其可以改善患者的神经功能和生活质量。

Objective To explore the clinical efficacy of Zhuyu Tongmai Capsule and Recombinant Human TNK Tissue-type Plasminogen Activator Injection in the treatment of acute cerebral infarction. Methods From August 2023 to September 2025, 110 patients with acute cerebral infarction admitted to Neurology Department of Xingtai Central Hospital were selected and divided into control group and treatment group according to random number method, with 55 cases in each group. Patients in control group were treated with Recombinant Human TNK Tissue-type Plasminogen Activator for injection, 0.9 mg/kg, with 10% of the drug administered by intravenous injection (1 min), and the remaining 90% administered by intravenous infusion (1 h). Patients in treatment group were given the oral medication of Zhuyu Tongmai Capsules, 2 capsules per time, 3 times daily, in addition to the treatment of control group. Both groups were treated for 14 d. The clinical efficacy of the two groups was observed, and the TCM syndrome scores, Modified Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS) score, growth arrest-specific protein 6 (GAS6), homocysteine (Hcy), fatty acid binding protein 4 (FABP4), and γ-interferon (IFN-γ) levels were compared between two groups. Results After treatment, the total effective rate of treatment group was 96.36%, significantly higher than that of control group (83.64%) (P < 0.05). After treatment, the scores of hemiplegia, deviation of the mouth and tongue, speech stammering, and limb numbness in both groups were all lower than those before the treatment (P < 0.05), and compared with control group, the scores of hemiplegia, deviation of the mouth and tongue, speech stammering, and limb numbness in the treatment group were all lower (P < 0.05). After treatment, the BI scores of both groups were higher than those before the treatment, but the NIHSS scores were lower than those before treatment (P< 0.05), and compared with control group, the BI scores of treatment group were higher, and the NIHSS scores of treatment group were lower (P < 0.05). After treatment, the levels of serum GAS6, Hcy, IFN-γ, and FABP4 in both groups were lower than those before treatment (P < 0.05), and compared with the control group, the levels of serum GAS6, Hcy, IFN-γ, and FABP4 in treatment group were also lower (P < 0.05). Conclusion The combination of Zhuyu Tongmai Capsules and recombinant human TNK tissue-type plasminogen activator has demonstrated excellent efficacy in treatment of acute cerebral infarction, particularly in improving the neurological function and life quality of patients.

R971

河北省医学科学研究课题计划项目（20251157）