替奈普酶在急性缺血性卒中治疗中应用的研究现状

Current status of tenecteplase in the treatment of acute ischemic stroke

静脉溶栓(IVT)是超早期再灌注治疗的主要手段。替奈普酶(TNK)是第三代溶栓药物,通过基因修饰改变重组组织型纤溶酶原激活剂(rt-PA)结构后获得,具有更高的血浆半衰期、更强的纤维蛋白结合特异性和更低的出血风险。多项研究显示,TNK在临床有效性和安全性方面与rt-PA相比具有潜在优势。对于发病4.5 h内的急性缺血性卒中(AIS)患者,TNK与rt-PA具有相似的疗效和安全性,并在某些研究中显示出更高的再灌注率和更好的功能结局。然而,TNK对超时间窗或醒后卒中患者的功能获益如何,尚需要更多高质量的研究证据。未来研究将继续探索TNK在超时间窗和未知发病时间AIS患者中的应用可能性。新指南已经开始推荐TNK作为rt-PA的替代方案,特别是在符合血管内治疗条件的患者中。本文就TNK在AIS治疗中应用的研究现状作一述评。

Intravenous thrombolysis(IVT)is the mainstay of ultra-early reperfusion therapy.Tenecteplase(TNK),a third-generation thrombolytic drug,has improved pharmacological properties through genetic modification,with higher plasma half-life,stronger fibrin binding specificity,and lower bleeding risk.Several studies have shown potential advantages of TNK over recombinant tissue plasminogen activator(rt-PA)in terms of clinical efficacy and safety.For patients with acute ischemic stroke(AIS)within 4.5 h of onset,TNK had similar efficacy and safety with rt-PA,and showed higher reperfusion rate and better functional outcome in some studies.However,the functional benefit of TNK in patients with an extended time window or wake-up stroke requires more high-quality research evidence.Future studies are expected to continue to explore the application of TNK in patients with AIS with an extended time window and unknown time of onset.New guidelines have begun to recommend TNK as an alternative to rt-PA,particularly in patients eligible for endovascular therapy.This article reviews the research status of TNK in AIS treatment.