急性脑梗死患者血浆溶血磷脂酸的检测及意义

DETECTION AND SIGNIFICANCE OF PLASMA LYSOPHOSPHATIDIC ACID IN PATIENTS WITH ACUTE INFARCTION

目的探讨急性脑梗死患者血浆溶血磷脂酸(LPA)的动态变化及其在脑梗死诊断中的意义。方法60例急性脑梗死分为大梗死灶组、中梗死灶组和小梗死灶组,动态检测患者血浆LPA浓度,分析其与梗死部位大小的相关性,并与健康体检者对照。受试者工作曲线(ROC)评价其在脑梗死发生中的诊断价值。结果①急性脑梗死发病后6h、24h、3d、7d、14d血浆LPA水平均高于对照组及脑梗死后遗症组,差异有统计学意义(P<0.05或P<0.01)。7d后下降明显,14d时接近正常水平。②大梗死灶组于发病6h内至7d各时间点血浆LPA水平显著高于中、小梗死灶组(P<0.05或P<0.01),14d后显著下降。中梗死灶组于发病24h至3d血浆LPA水平显著高于小梗死灶组(P<0.05),7d后显著下降,14d接近正常。小梗死灶组于6h内达高峰,以后很快下降。③以血浆中的LPA1.70μmol/L为临界值,实验室诊断参数灵敏度、特异性、阳性预测值、阴性预测值及ROC下面积分别为92.8%、80.0%、92.9%、82.6%和0.85。结论血浆中LPA的改变与急性脑梗死的发生与进展密切相关,可作为急性脑梗死的诊断和疗效判断的指标。

Objective To investigate the relationship between stroke and plasma lysophosphatidic acid （LPA）, and the value in infarction diagnosis. Methods All the patients were divided into three groups： large infarction group, middle infarction group and small infarction. The plasma LPA content ration of patients with acute infarction was analyzed and compared with those of patients with stable infarction and healthy control respectively, the relation of which to the infarction location and the size was studied as well. Results ①The content of plasma LPA during acute time with infarction patients was significantly higher than that in control group （P〈0.05 or P〈0.01）. ②The content of plasma LPA of large infarction group was significantly higher than those in middle infarction group and small infarction group. ③At the critical point of 1.70μmol/L plasma LPA, the sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating characteristics curve were 92.8%, 80.0%, 92.9%, 82.6%, and 0. 85, respectively. Conclusion The content change of plasma LPA has an association with occurrence and improvement of infarction, it may serve as an impersonal marker of infarction diagnosis.