急性脑卒中患者血清溶血磷脂酸和同型半胱氨酸水平变化及其与预后的关系

摘要

目的：观察急性脑卒中患者血清溶血磷脂酸（ LPA）和同型半胱氨酸（ HCY）水平变化及其与预后的相关性。方法选择2014年1月—2015年12月上海交通大学医学院附属第九人民医院北部神经内科收治的急性脑卒中患者99例作为研究对象（病例组），其中缺血性脑卒中52例，出血性脑卒中47例；初发性脑卒中56例，复发性脑卒中43例；轻度损伤27例，中度损伤44例，重度损伤28例。并选取同期在我院进行健康体检的志愿者50例为健康对照组，检测2组血清LPA和HCY水平变化，并对其与预后的关系进行相关分析。结果治疗后3个月，存活85例，死亡4例，死亡患者的血清LPA和HCY水平显著高于存活患者（ P ＜0．05），病例组患者的血清LPA和HCY水平高于健康对照组（ P ＜0．05），缺血性脑卒中患者均显著高于出血性脑卒中患者（ P ＜0．05），复发性脑卒中患者均高于初发脑卒中患者（ P ＜0．05）；轻度神经损伤、中度神经损伤、重度神经损伤急性脑卒中患者LPA和HCY水平依次升高，差异均有统计学意义（ P ＜0．05）。血清LPA和HCY水平与NIHSS评分呈正相关关系（ r ＝0．613、0．711， P ＜0．05），与BI评分均呈负相关关系（ r ＝－0．774、－0．692， P ＜0．05），与患者病死率呈正相关关系（ r ＝0．577、0．413， P ＜0．05）。结论急性脑卒中患者血清LPA及HCY水平明显升高，且病情越严重上升越明显，可以作为急性脑卒中病情诊断、预后预测的血液学指标。%Objective To investigate the changes and relationship of lysophosphatidic acid ( LPA) and homocysteine ( HCY) with prognosis in acute stroke patients.Methods Eighty-nine acute stroke patients and 50 cases of healthy volunteers from January 2014 to December 2015 were enrolled into this study.Among the patients, ischemic stroke in 52 cases, hemor-rhagic stroke in 47 cases, primary stroke in 56 cases, recurrent stroke in 43 cases, mild damage in 27 cases, moderate dam-age in 34 cases, severe injury in 28 cases.The serum LPA and HCY levels were detected.Results The serum LPA and HCY levels in dead patients were higher than those in survived patients ( P <0.05);the serum LPA and HCY levels in the acute stroke patients were significantly higher than those in healthy volunteers, the difference was statistically significant ( P <0.05);the serum LPA and HCY levels in the ischemic stroke patients were significantly higher than those in cerebral hemor-rhage patients( P <0.05); the serum LPA and HCY levels in the recurrent stroke patients were significantly higher than those in the primary stroke patients, the differences were statistically significant (P <0.05);the serum LPA and HCY levels increased with the aggravation of the disease.The serum LPA and HCY levels were positive correlation with NIHSS scores (r =0.613, r =0.711, P <0.05), negative correlation with the BI scores (r =-0.774, r =-0.692, P <0.05) and positive correlation with death ( r =0.577, r =0.413, P <0.05).Conclusion The serum LPA and HCY levels in the a-cute stroke patients increased significantly, and as the pathogenic conditions, increased more higher.The serum LPA and HCY levels could be used as the indexes to make diagnosis and estimate the prognosis for acute stroke disease.