急性脑梗死患者血浆溶血磷脂酸水平的临床意义及厄贝沙坦对其影响

目的:探讨急性脑梗死早期血浆溶血磷脂酸(LPA)水平变化的临床意义及厄贝沙坦对其影响。方法:急性脑梗死患者100例为病例组,随机分为厄贝沙坦亚组和常规亚组各50例,厄贝沙坦亚组给予厄贝沙坦+阿司匹林,常规亚组给予阿司匹林,连续治疗14 d。分别检测病例组治疗前后血浆LPA浓度,进行神经功能缺损程度评分,分析其与梗死部位、大小、病因、病情的相关性,并另选择50例健康体检者为对照组。结果:急性脑梗死患者血浆LPA急性期升高,和对照组比较有显著性差异(P0.01)。大梗死灶患者血浆LPA浓度较小梗死灶者高(P0.01);重型患者血浆LPA浓度高于轻型患者(P0.01);不同病因的脑梗死患者血清LPA水平均高于对照组,分别为心源性大动脉型其他类型小动脉型对照组(P0.05)。厄贝沙坦亚组和常规亚组治疗后LPA和神经功能缺损评分较治疗前显著降低(P0.01),治疗后与常规亚组比较,厄贝沙坦亚组的LPA含量和神经功能缺损评分降低更为明显(P0.01)。结论:血浆LPA浓度与梗死大小、部位、病因、病情严重程度相关,可作为脑梗死的预警因子。厄贝沙坦能显著降低急性脑梗死患者血浆LPA含量,对缺血性脑血管病的防治具有重要的临床应用价值。

The Clinical Significance of Plasma Lysophosphatidic Acid Level in Patients with Acute Cerebral Infarction and the Effect of Irbesartan on the Plasma Concentrations of Lysophosphatidic Acid

Objective:To study the levels of plasma lysophosphatidic acid(LPA) and its clinical significance in patients with acute cerebral infarction,and to explore the effects of Irbesartan on the plasma concentrations of lysophosphatidic acid.Methods:One-hundred patients with acute cerebral infarction were randomly assigned to Irbesartan therapy group(n=50) treated with Irbesartan and Aspirin,and conventional therapy group(n=50) treated with Aspirin for 14 days.The levels of LPA in venous blood were measured and the correlation with infarct location,size,etiology was assessed.The scores of neurological deficits(NDS) were evaluated before and after treatment.Another 50 normal healthy people were recruited as controls.Results:The plasma LPA in patients with acute cerebral infarction increased significantly relative to that in the control group(P<0.01).The LPA level correlates positively with infarction size and severity.The LPA levels in various patients ran the following order:cardiogenic cerebral embolism,large vascular sclerosis,other type,and microangiopathy(P<0.05).After treatment with Irbesartan,LPA level and NDS were significantly deceased(P<0.01).Conclusion:The level of plasma LPA are associated with the etiology and infarction size.Irbesartan can decrease LPA in patients with acute cerebral infarction and could be used effectively for patients with ischemic cerebral infarction.