急性脑血栓形成患者血小板活化标记物的临床监测

Detection of platelet activation marker in patients with acute cerebral thrombosis

目的观察急性脑血栓形成(CT)患者血浆溶血磷脂酸(LPA)含量的动态变化,探讨LPA在CT的发生以及病情演变过程中反映血小板活化状态的作用,为临床抗血小板的个体化治疗方案提供客观依据。方法采用比色法监测30例CT患者病后24 h内、7、21 d的血浆LPA浓度,并与20名健康人作对照。CT患者在发病24 h内同时测定血脂水平并进行中国卒中量表CSS评分,分别对CT患者发病24 h以内的血浆LPA水平、血清低密度脂蛋白(LDL)和神经功能缺损程度进行相关性分析。结果与健康对照组相比,CT患者发病24 h内血浆LPA含量明显升高(P<0.01);发病7 d有所降低,但仍高于健康对照组(P<0.01);发病21 dCT组与健康对照组比较LPA水平差异无统计学意义(P>0.05)。发病后24 h内血浆LPA浓度与CSS评分呈正相关(r=0.523,P<0.01)。发病后24 h内血浆LPA浓度与血清LDL无显著相关性(r=0.282,P>0.05)。结论CT患者急性期血浆LPA水平升高,而后随着病情的稳定、好转,血浆LPA水平逐渐下降,至发病3周时LPA指标接近于正常水平。发病24 h内LPA浓度与神经功能缺损程度呈正相关,血浆LPA的变化反映了脑血栓形成患者体内血小板的活化状态,可作为CT性脑梗死体内凝血和血栓形成的标记物之一。

Objective To observe the dynamic changes of plasma lysophosphatidic acid （LPA） in patients with acute cerebral thrombosis （CT）, investigate the role of plasma LPA in reflecting the blood platelet activated state during the process of CT occurrence and development and provide objective evidence for individualized therapy of anti-blood platelets. Methods Plasma LPA levels in 30 patients with acute CT and 20 healthy persons as normal controls were serially detected by colorimetry on days 1, 7 and 21 after the onset, the neurological status was evaluated by Chinese stroke scale （CSS）, and blood fat was detected in 30 patients at 24 h after onset. The relevant analysis among CSS, low density lipoprotein （LDL） and plasma LPA was performed. Results When compared with the control group, the concentration of LPA in plasma became higher in CT 24 h after onset （ P 〈0.01）, then it declined slowly, but still higher than that of controls on the 7th day （P 〈0. 01）. There was no significant difference between the two groups on the 21st day after onset （P 〉0.05）. The concentrations of LPA in plasma were positively correlated with CSS at 24 h after onset （r=0.523, P 〈0.01）. There was not a positive relationship between the degree of LPA and LDL in early CT （r=0.282, P 〉0.05）. Conclusion Plasma LPA level increases in the acute stage of CT, then it drops gradually as the patients＇ condition becomes stable and improved, and closes to normal on the 21st day after onset. The concentration of plasma LPA is positively correlated with clinical neurologic impairment score within 24 h of CT onset, and the changes of LPA in plasma reflect the blood platelet activated state; therefore, plasma LPA can be used as one of the molecular markers in observing the coagulation and thrombosis of patients with acute CT.