目的 探討依洛尤單抗聯(lián)合阿替普酶治療大動脈粥樣硬化性、Fazekas量表評分為重度的急性腦梗死患者的臨床療效。方法 選取2021年1月—2022年11月天津市北辰醫(yī)院腦神經(jīng)科收治的112例大動脈粥樣硬化性、Fazekas量表評分為重度的急性腦梗死患者，按隨機數(shù)字表法將所有患者分為對照組和治療組，每組各56例。對照組患者給予注射用阿替普酶，按照0.9 mg/kg計算，最高劑量不超過90 mg，總劑量的10%靜脈慢推1 min，其余90%藥物靜脈點滴1 h。治療組在對照組的基礎(chǔ)上皮下給藥依洛尤單抗注射液，140 mg/次，1次/2周。兩組治療2周。觀察兩組的臨床療效和癥狀緩解時間，比較兩組治療前后血脂指標和血清細胞因子的變化情況。結(jié)果 治療后，治療組患者總有效率是92.86%，顯著高于對照組的80.36%（P＜0.05）。治療后，治療組偏側(cè)肢體無力、口角歪斜、吞咽異常、偏側(cè)肢體麻木緩解時間均顯著短于對照組（P＜0.05）。治療后，兩組總膽固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）水平均較同組治療前顯著降低，而高密度脂蛋白（HDL-C）水平顯著升高（P＜0.05）；治療后，治療組血脂水平改善優(yōu)于對照組（P＜0.05）。治療后，兩組神經(jīng)損傷100β蛋白（S100β）、血清細胞間黏附因子-1（ICAM-1）、神經(jīng)元特異性烯醇化酶（NSE）、腫瘤壞死因子α（TNF-α）水平均低于同組治療前（P＜0.05）；且治療后，治療組S100β、ICAM-1、NSE、TNF-α水平低于對照組（P＜0.05）。結(jié)論 依洛尤單抗聯(lián)合阿替普酶治療大動脈粥樣硬化性、Fazekas量表評分為重度的急性腦梗死具有較好的臨床療效，可加快緩解患者的臨床癥狀，并可有效調(diào)節(jié)患者血脂水平，降低機體炎癥反應，值得借鑒應用。

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

天津市北辰區(qū)科技計劃項目（SHGY-2020005）