脑出血患者血浆溶血磷脂类分子含量变化的研究以及微创血肿清除术的疗效

A Clinical Study of Plasma Lysophospholipids Levels in Patients with Intracerebral Hemorrhage and Effects of Mini-invasive Evacuation of Hematoma

目的观察脑出血患者血浆溶血磷脂类分子(LPA/AP)含量变化的特点以及微创血肿清除术联合镁制剂的影响,探索脑出血后病理生理学机制及有效的干预方法。方法选取脑出血患者328例,测定其血浆溶血磷脂酸(LPA)及其相似磷脂(AP)的含量变化,并与359例脑梗死患者进行比较,年龄匹配的健康体检者作为对照组。同时观察微创血肿清除术及镁制剂对脑出血患者血浆LPA、AP含量及预后的影响。结果发病24h脑梗死组血浆LPA的含量[(4.23±0.61)μmol/L]显著高于脑出血组[(2.66±0.44)μmol/L,P<0.01]及对照组[(2.54±0.39)μmol/L,P<0.01]。脑出血组血浆AP含量[(6.65±0.76)U]显著高于脑梗死组[(5.35±0.57)U,P<0.01]及对照组[(4.09±0.48)U,P<0.01]。发病1周、2周,脑出血组血浆AP含量仍高于脑梗死组和对照组(P<0.01)。微创钻颅血肿清除术及镁制剂治疗能够显著降低脑出血患者血浆AP含量(P<0.01),改善患者预后。结论脑出血患者血浆AP含量显著升高,提示脑出血后2周内均存在膜损伤;微创钻颅血肿清除术联合镁制剂治疗能够有效降低血浆AP含量,改善患者预后,具有神经保护作用。

Objective To investigate the changes of plasma lysophosphatidic acid (LPA) and acidic phospholipid (AP) levels in patients with intracerebral hemorrhage (ICH) and to evaluate whether the treatment with mini-invasive evacuation of hematoma combined with magnesium sulfate will decrease the AP level and affect patients’ outcome. Methods We examined plasma LPA and AP levels using fresh fetched blood in 328 cases of ICH, 310 controls and 359 cases of ischemic stroke enrolled in our study. Meanwhile, the effects of mini-invasive evacuation of hematoma combined with magnesium sulfate on plasma LPA/AP levels and patients’ prognosis were observed. Results Within 24 hours after onset, a signifi cantly elevated LPA level was seen in cases (n=359) with ischemic stroke [(4.23±0.61)μmol/L], compared with control group[(2.54±0.39)μmol/L, (P<0.01)] and ICH group[(2.66±0.44)μmol/L, (P<0.01)]. AP level significantly increased in ICH group [(6.65±0.76)U], when compared with the control group [(4.09±0.48)μmol/L, P<0.01] and ischemic stroke group[(5.35±0.57)U, P<0.01]. The high level of AP in ICH group lasted 2 weeks. Mini-invasive evacuation of hematoma combined with intravenous magnesium sulfate signifi cantly lowered the patients’ AP level compared with administration of medicine expectant treatment(P<0.01), and functional assessment of neurologic system was obviously improved (P<0.01). Conclusion The plasma AP level increases in acute stage of ICH, which suggests a close association between ICH and ischemic membrane injury. Mini-invasive evacuation of hematoma combined with magnesium sulfate can effectively reduce the plasma AP level and improve patients’ prognosis.