不同亚型分水岭脑梗死患者血浆溶血磷脂酸水平变化及意义

摘要

目的：探讨不同亚型急性分水岭脑梗死（ WSI）患者血浆溶血磷脂酸（ LPA）水平的变化及其临床意义。方法选取脑梗死患者73例，根据影像学检查结果将其分为WSI 45例（ WSI组）和非分水岭区大面积脑梗死28例（对照组）；WSI组又包括皮质层型CWSI 22例（前皮质型9例和后皮质型13例）（ CWSI组）、皮质下IWSI 23例（融合病灶型11例与非融合病灶型12例）（ IWSI组）。检测不同亚型WSI患者血浆LPA水平及颅内动脉病变情况。结果不同类型脑梗死患者血浆LPA水平比较，CWSI组高于IWSI组（P＜0．05），IWSI组低于对照组（P＜0．05），融合型IWSI高于非融合型IWSI（P＜0．05）。 CWSI易合并大脑中动脉及大脑后动脉狭窄；IWSI（尤其是融合型IWSI）易合并颈内动脉狭窄。结论不同亚型WSI患者血浆LPA水平存在差异，检测血浆LPA水平对判断WSI分型及提示可能的发生机制有重要意义。%Objective To investigate the changes in levels of plasma lysophosphatidic acid ( LPA) in patients with different types of acute cerebral watershed infarction ( WSI) and its clinical significance.Methods Seventy-three patients with cerebral infarction were selected.According to the imageological examination, they were divided into two groups:the WSI group (45 cases) and the control group (28 cases of patients with massive cerebral infarction in non-watershed area). The WSI group included 22 cases of cortical WSI ( CWSI group, frontal 9 cases of anterior cortical type and 13 cases of pos-terior cortical type) and 23 cases of subcortical WSI or internal watershed infarction ( IWSI group, 11 cases with fused le-sion and 12 cases with non-fused lesion) .The plasma LPA levels of patients with different subtypes of WSI were compared as well as the intracranial artery lesions.Results The plasma LPA levels in the CWSI group were significantly higher than those in the IWSI group (P<0.05), and the IWSI group was lower than the control group (P<0.05).For IWSI, the plasma LPA levels in the fusion type were higher than those of the non-fusion type (P<0.05).CWSI was easy to combine with middle and posterior cerebral artery stenosis, while the internal carotid artery stenosis was more common to be seen in IWSI, especially in IWSI with fused lesions.Conclusion There are differences in plasma LPA levels of patients with dif-ferent subtypes of WSI, and detecting the plasma LPA level has important significance in judging the WSI types and sugges-ting the possible mechanism.