老年分水岭脑梗死患者血浆溶血磷脂酸水平的变化及其临床意义  

Changes of plasma lysophosphatidic acid and its clinical significance in elderly patients with supratentorial cerebral watershed infarction

作　　者：王道珍[1] 李振光[1] 王远臣[1] 迟相林[1] 

机构地区：[1]潍坊医学院附属文登中心医院神经内科,山东威海264400

出　　处：《中国医师进修杂志》2010年第1期16-18,共3页Chinese Journal of Postgraduates of Medicine

基　　金：山东省医药卫生科技发展计划（2007HW020）

摘　　要：目的探讨老年分水岭脑梗死（CWI）的类型、临床特点及与血浆溶血磷脂酸（IJPA）水平的关系。方法分析106例经头颅MRI证实为CWI患者（CWI组）的临床资料，比较不同类型CWI患者与36例非CWI患者（非CWI组）及32例门诊健康查体者（健康对照组）血浆LPA水平的变化。结果CWI组中皮层前型22例，血浆LPA水平为（4．93±0．72）μmol／L；皮层后型17例，血浆LPA水平为（4．75±0．81）μmol／L；皮层下型47例，血浆LPA水平为（5．46±1．03）μmol／L；混合型20例，血浆LPA水平为（6．02±1．12）μmol／L。非CWI组血浆LPA水平为（5．37±1．24）μmol／L；健康对照组血浆LPA水平为（2．92±0．36）斗mol／L。不同类型CWI患者与健康对照组比较，血浆LPA水平均明显升高，差异有统计学意义（P〈0．05或〈0．01），其中混合型最高，皮层下型次之，混合型与皮层前型及皮层后型比较差异有统计学意义（P〈0．05）；非CWI组血浆LPA水平明显高于健康对照组，但与不同类型CWI患者比较差异无统计学意义。结论老年CWI以皮层下型为主，病因主要为动脉粥样硬化斑块形成及血管腔狭窄，血小板活化及其产生的微栓子在老年CWI的病理生理学中发挥重要作用；LPA水平在老年不同类型CWI患者血浆中均明显增高，其中又以混合型最高，可作为重要的分子标志物指导老年CWI的分型治疗。Objective To study the clinical type and features of cerebral watershed infarction （CWI） in elderly patients and its relationship with plasma lysophosphatidic acid （LPA）. Method Analyzed the clinical data of 106 cases of CWI patients （CWI group） confirmed by cranial MRI, and compared plasma LPA levels in patients with different types of CWI, non-CWI patients（non-CWI group, 36 cases） and healthy controls （control group, 32 cases）. Results In CWI group, anterior-cortex type 22 cases, LPA （4.93 ± 0.72 ） μ mol/L, posterior-cortex type 17 cases, LPA （4.75 ± 0.81 ） μ mol/L, subcortical type 47 cases, LPA （5.46 ：t 1.03） μ mol/L,mixed type 20 cases,LPA （6.02 ± 1.12） μ mol/L. In non-CWI group, LPA （5.37 ± 1.24） μ mol/L. In control group, LPA （2.92 ± 0.36） μ mol/L. The levels of LPA significantly increased in various types of C WI （P 〈 0.05 or 〈 0.01 ）, of which mixed type and subcortical type were the highest, and the level of LPA in mixed type was higher than that in anterior-cortex type and posterior-cortex type （P 〈 0.05 ）. The level of LPA in non-CWI group was higher than that in control group,but there was no significant difference compared with various types of CWI. Conclusions Subcortical type is the primal type in elderly CWI patients,the main cause of which is the atherosclerotic plaque formation and lumen stenosis. Platelet activation and its microemboli play an important role in the pathophysiology. LPA levels are significantly higher in various typos of CWI, of which mixed type is the highest. LPA can be used as an important molecular marker to guide the sub-type treatment of CWI in elderly patients.

关 键 词：分水岭脑梗死 溶血磷脂素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]