奥扎格雷钠联合阿司匹林对急性脑梗死患者血浆溶血磷脂酸和酸性磷脂水平的影响及意义

目的探讨奥扎格雷钠联合阿司匹林对急性脑梗死患者血浆溶血磷脂酸（LPA）和酸性磷脂（AP）水平的影响及临床疗效。方法将131例脑梗死患者随机分为奥扎格雷钠组（66例）和阿司匹林组（65例）,两组均给予拜阿司匹灵、丹参注射液治疗,奥扎格雷钠组加用奥扎格雷钠治疗1个疗程（15d）。分别于治疗前后测定患者血浆LPA和AP水平并与健康对照组比较。应用中国脑卒中量表（CSS）进行神经功能转归评价。结果急性脑梗死患者治疗前血浆LPA和AP水平显著高于健康对照组（P〈0.01）,治疗后奥扎格雷钠组与健康对照组比较差异无统计学意义,血浆LPA、AP水平及CSS评分均较阿司匹林组明显改善（分别为P〈0.05,P〈0.01）。结论奥扎格雷钠联合阿司匹林可显著降低急性脑梗死患者血浆LPA和AP水平,抑制血小板聚集,促进神经功能恢复。     

超微剂量低分子肝素治疗新生儿硬肿症疗效及其对血液流变学的影响

目的探讨超微剂量低分子肝素治疗新生儿硬肿症的疗效及其对血液流变学的影响。方法48例新生儿硬肿症患儿，随机分成两组：治疗组（26例）和对照组（22例）。两组患儿均采用综合治疗，治疗组在综合治疗的基础上加用超微剂量低分子肝素6U／（kg·次）皮下注射，每6h1次，至硬肿消退后停药。两组患儿均于入院时及治疗后5d，测定血液流变学指标，并观察两组复温时间、硬肿消失时间、住院天数。结果治疗组与对照组复温时间分别为（6．75±2．83）h和（9．45±3．25）h，硬肿消失时间分别为（3．98±1．85）d和（6．35±2．33）d，住院天数分别为（6．07±3．41）d和（9．83±4．62）d，两组比较差异均有统计学意义（P〈0．01）。治疗后两组较治疗前血液流变学均有明显改善，而治疗组治疗后较对照组治疗后血液流变学改善更为明显[全血黏度高切：（4．42±0．52）mPa·s和（4．97±0．65）mPa·s，血浆黏度：（1．36±0．18）mPa·s和（1．61±0．23）mPa·s，RBC聚集指数：6．69±1．23和7．98±1．45，RBC电泳时间：（13．47±1．68）s和（15．39±1．75）s，RBC变形指数：0．98±0．18和0．83±0．15]，两组比较差异均有统计学意义（P〈0．01）。结论超微剂量的低分子肝素治疗新生儿硬肿症后，血液流变学明显改善，临床疗效确切。且无出血等不良反应。     

抑郁对卒中急性期患者早期康复的影响

目的探讨抑郁与卒中急性期患者早期康复的关系。方法选择卒中急性期并发抑郁（PSD）患者144例，随机分为抑郁干预组及抑郁未干预组，并与同期卒中急性期不伴有抑郁患者72例（单纯卒中组）作对照。全部患者均按卒中常规治疗，抑郁干预组在此基础上给予心理治疗或抗抑郁剂合并心理治疗；各组分别在治疗前、治疗后1、2．4周进行汉密尔顿抑郁量表（HAMD）、中国卒中量表（CSS）、改良Barthel指数记分法（MBI）评分。结果卒中急性期PSD患者（抑郁干预组及抑郁未干预组）与单纯卒中组相比，神经功能恢复较差（P〈0．05，P〈0．01）；抑郁未干预组CSS及MBI的改善明显低于抑郁干预组（P〈0．01）。结论卒中急性期PSD能严重影响患者的早期康复，可作为卒中预后的评估方法之一。早期抑郁干预可明显改善患者的神经功能和生活能力。     

伴有阻塞性睡眠呼吸暂停综合征的急性脑梗死患者血浆溶血磷脂含量的测定

Objective To observe the changing characteristics of plasma lysophosphatidic acid (LPA) or acidia phospholipid (AP) levels in patients with obstructive sleep apnea syndrome-associated(OSAS)acute cerebral infarction and to explore the pathophysiological mechanisms of OSAS-related stroke so as to provide basis for clinical antithrombotic therapy. Methods Thirty-six patients of OSAS, 32 patients of OSAS-related acute stoke and 36 patients of acute stoke without OSAS diagnosed by clinical and accessory examinations were enrolled in the current study. Thirty-eight age-matched healthy subjects were recruited as controls. The changes of the plasma LPA and AP levels were measured. Results Within 24 hours after symptom onset, the plasma LPA and AP levels in the OSAS-related acute cerebral infarction group (LPA(3. 78 ±0. 56) μmol/L; AP(7. 63 ± 1. 38) μmol/L) were significantly higher than those in the OSAS group(LPA(3. 17 ±0. 65) μmol/L; AP(6. 60 ± 1. 20) μmol/L) ,the not OSAS-related acute cerebral infarction group (LPA (3. 40 ± 0. 59)μmol/L; AP (6. 41 ± 1. 37)μmol/L) and the control group (LPA(2.76±0.45)μmol/L;AP(4.52±0. 83) μmol/L (P < 0. 01)) . The levels of LPA and AP in the OSAS group and the not OSAS-related acute cerebral infarction group were significantly higher than those in the control group(P<0. 01). Seven days after symptom onset, the plasma LPA and AP levels in the OSAS-associated acute cerebral infarction group (LPA(3.08 ± 0. 58) μmol/L; AP(6. 15 ±1. 14)μmol/L) were still higher(P < 0. 01) . The plasma LPA levels were not significantly different among the OSAS-related acute cerebral infarction group, the not OSAS-related acute cerebral infarction group and the control group 21 days after symptom onset, whereas the plasma AP levels in the OSAS-related acute cerebral infarction group (5. 04 ± 0. 83) μmol/L were still significantly higher than those in the not OSAS-related acute cerebral infarction group (4. 57 ± 0. 94) μmol/L and the control group (P < 0.05). Conclusions The significantly elevated plasma LPA and AP levels in patients with OSAS suggested that platelets in vivo are in an activated state and in cerebral ischemia and hypoxia state, especially for the OSAS-related acute cerebral infarction patients. The activated state of platelet may persist for a long time, thus the time window for antithrombotic therapy may be longer.     

阻塞性睡眠呼吸暂停综合征患者血浆脂蛋白相关磷脂酶A_2含量的变化

目的观察阻塞性睡眠呼吸暂停综合征(OSAS)患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平的变化特点,探索OSAS相关性脑卒中的病理生理学机制,为临床抗栓治疗提供依据。方法经临床和辅助检查确诊的OSAS患者40例(OSAS组)、伴OSAS的急性脑梗死患者36例(OSAS伴脑梗死组)以及不伴OSAS的急性脑梗死患者38例(脑梗死组)纳入本研究,另选取年龄、性别匹配的36名健康者作为对照组。采用ELISA法检测各组血浆Lp-PLA2水平。结果发病24h时,OSAS组、OSAS伴脑梗死组以及脑梗死组患者血浆LpPLA2水平均显著高于对照组(均P0.01),且OSAS伴脑梗死组血浆Lp-PLA2水平高于OSAS组和脑梗死组(均P0.01)。至发病后21d,OSAS伴脑梗死组患者血浆Lp-PLA2含量仍高于脑梗死组和对照组(P0.01),而脑梗死组和对照组血浆Lp-PLA2水平比较差异无统计学意义(P0.05)。结论 OSAS患者血浆LpPLA2水平升高,提示其体内存在Lp-PLA2相关性炎性反应,LP-PLA2可作为一种理想的分子标记物用于判断OSAS患者体内炎性反应状态;OSAS伴脑梗死患者炎性反应明显且持续时间较长,可能为早期强化抗炎治疗提供理论依据。     

急性脑梗死患者血浆S-100蛋白含量的动态变化及其临床意义

目的研究急性脑梗死（ACI）患者血浆S-100蛋白含量的动态变化及其临床意义。方法采用酶联免疫吸附法（ELISA）检测30例ACI患者病后1d、2d、3d、5d、7d、10d的血浆S-100蛋白浓度,并与30名健康人作对照;在发病1d、10d进行中国卒中量表（CSS）评分。结果与对照组相比,ACI患者发病1d血浆S-100蛋白含量即明显升高（P〈0.01）,2~3d达到峰值,5d下降,7d降至正常;大面积脑梗死患者血浆S-100蛋白含量高于中、小面积梗死患者,中面积梗死又高于小面积梗死患者（P〈0.05~0.01）。发病后1-5d血浆S-100蛋白浓度与CSS呈正相关（r=0.468-0.642,均P〈0.01）。结论ACI患者血浆S-100蛋白含量的变化可以反映疾病的严重程度,对指导治疗、评估预后有重要意义。     

伴有阻塞性睡眠呼吸暂停综合征的急性脑梗死患者血浆溶血磷脂含量的测定

Objective To observe the changing characteristics of plasma lysophosphatidic acid (LPA) or acidia phospholipid (AP) levels in patients with obstructive sleep apnea syndrome-associated(OSAS)acute cerebral infarction and to explore the pathophysiological mechanisms of OSAS-related stroke so as to provide basis for clinical antithrombotic therapy. Methods Thirty-six patients of OSAS, 32 patients of OSAS-related acute stoke and 36 patients of acute stoke without OSAS diagnosed by clinical and accessory examinations were enrolled in the current study. Thirty-eight age-matched healthy subjects were recruited as controls. The changes of the plasma LPA and AP levels were measured. Results Within 24 hours after symptom onset, the plasma LPA and AP levels in the OSAS-related acute cerebral infarction group (LPA(3. 78 ±0. 56) μmol/L; AP(7. 63 ± 1. 38) μmol/L) were significantly higher than those in the OSAS group(LPA(3. 17 ±0. 65) μmol/L; AP(6. 60 ± 1. 20) μmol/L) ,the not OSAS-related acute cerebral infarction group (LPA (3. 40 ± 0. 59)μmol/L; AP (6. 41 ± 1. 37)μmol/L) and the control group (LPA(2.76±0.45)μmol/L;AP(4.52±0. 83) μmol/L (P < 0. 01)) . The levels of LPA and AP in the OSAS group and the not OSAS-related acute cerebral infarction group were significantly higher than those in the control group(P<0. 01). Seven days after symptom onset, the plasma LPA and AP levels in the OSAS-associated acute cerebral infarction group (LPA(3.08 ± 0. 58) μmol/L; AP(6. 15 ±1. 14)μmol/L) were still higher(P < 0. 01) . The plasma LPA levels were not significantly different among the OSAS-related acute cerebral infarction group, the not OSAS-related acute cerebral infarction group and the control group 21 days after symptom onset, whereas the plasma AP levels in the OSAS-related acute cerebral infarction group (5. 04 ± 0. 83) μmol/L were still significantly higher than those in the not OSAS-related acute cerebral infarction group (4. 57 ± 0. 94) μmol/L and the control group (P < 0.05). Conclusions The significantly elevated plasma LPA and AP levels in patients with OSAS suggested that platelets in vivo are in an activated state and in cerebral ischemia and hypoxia state, especially for the OSAS-related acute cerebral infarction patients. The activated state of platelet may persist for a long time, thus the time window for antithrombotic therapy may be longer.     

伴有阻塞性睡眠呼吸暂停综合征的急性脑梗死患者血浆溶血磷脂含量的测定

目的 观察伴有阻塞性睡眠呼吸暂停综合征(OSAS)的急性脑梗死患者血浆溶血磷脂含量的变化特点,探索OSAS相关性卒中的病理生理学机制,为临床抗栓治疗提供依据.方法 经临床和辅助检查确诊的36例OSAS患者、32例伴有OSAS的急性脑梗死患者以及36例不伴有OSAS的急性脑梗死患者纳入本研究.测定其血浆溶血磷脂酸(LPA)及其极性相似总磷脂(AP)的含量变化,年龄匹配的健康体检者38名作为健康对照组.结果 发病24 h血浆LPA及AP含量,伴OSAS的脑梗死组患者[LPA:(3.78±0.56)μmol/L;AP:(7.63±1.38)μmoL/L]显著高于OSAS组[LPA:(3.17 ±0.65)μmol/L;AP:(6.60 ±1.20)μmoL/L]、不伴OSAS的脑梗死组[LPA:(3.40±0.59)μmol/L;AP:(6.41±1.37)μmol/L]和健康对照组[LPA:(2.76±0.45)μmol/L;AP:(4.52±0.83)μmol/L](P均<0.01),OSAS组及不伴OSAS的脑梗死组患者显著高于健康对照组(P均<0.01).发病后7 d,伴OSAS的脑梗死组血浆LPA及AP含量仍显著升高[LPA:(3.08 ±0.58)μmol/L;AP:(6.15 ±1.14)μmol/L](P均<0.01);发病后21 d,伴OSAS的脑梗死组、OSAS组、不伴OSAS的脑梗死组血浆LPA含量无差异,伴OSAS的脑梗死组血浆AP[(5.04±0.83)μmol/L]仍高于不伴有OSAS的急性脑梗死组[(4.57±0.94)μmol/L]及健康对照组(P<0.05).结论 OSAS患者血浆LPA、AP含量显著升高,持续时间长,提示其体内血小板处于活化及脑缺血缺氧状态,OSAS相关性脑梗死患者尤为明显,故其抗栓治疗的时间窗应较长.     

CHA2DS2-VASc评分联合血浆脂蛋白相关磷脂酶A2水平预测非瓣膜病心房颤动患者脑梗死风险的研究

目的探讨CHA2DS2-VASc评分联合血浆脂蛋白相关磷脂酶A2水平(Lp-PLA2)对非瓣膜病心房颤动(NVAF)患者脑梗死风险的预测价值。方法入选广州医科大学附属惠州医院住院的242例NVAF患者,记录入院时血浆Lp-PLA2水平,计算CHA2DS2-VASc评分。出院后每3个月随访1次,随访期间发生缺血性脑卒中或随访满1a随访结束,根据随访结果分为脑梗死组和非脑脑梗死组。结果脑梗死组CHA2DS2-VASc评分、Lp-PLA2水平比非脑梗死组偏高。经Logistic回归分析证实,高CHA2DS2-VASc评分、高Lp-PLA2水平为NVAF患者发生脑梗死的危险因素。CHA2DS2-VASc评分、Lp-PLA2水平、CHA2DS2-VASc评分联合Lp-PLA2水平预测NVAF患者发生脑梗死的受试者工作特征(ROC)曲线下面积分别为0.815、0.796、0.879。结论 CHA2DS2-VASc评分联合Lp-PLA2水平可提高对NVAF患者发生脑梗死风险的预测价值。