脑梗死患者血浆溶血磷脂酸及基质金属蛋白酶-9与颈动脉斑块稳定性研究

Relationship of lysophosphatidic acid and matrix metalloproteinas-9 with carotid atheromatous plaque stability in patients with cerebral infarction

目的探讨脑梗死患者血浆溶血磷脂酸（lysophosphatjdjc acid，LPA）及基质金属蛋白酶-9（matrix metalloproteinase-9，MMP-9）水平与颈动脉粥样斑块稳定性的关系。方法选取87例脑梗死患者，根据颈动脉超声检查结果，分为无斑块组9例、内膜增厚组16例、不稳定性斑块组41例、稳定性斑块组21例。根据经颅多普勒（TCD）微栓子检测结果，分为微栓子检测阳性组27例和阴性组60例。分别用无机磷定量法和酶联免疫吸附法测定血浆LPA和MMP-9水平。结果不稳定性斑块组LPA、MMP9显著高于其他各组（F=49．98、106．49，均P=0．00），稳定性斑块组、内膜增厚组MMP-9差异无统计学意义，但均高于无斑块组（q=7．04、7．51，均P=0．00），稳定性斑块组LPA高于内膜增厚组（q=7．37，P=0．00），并且两组均高于无斑块组（q=8．85，P=0．00；q=2．61，P=0．04）。微栓子阳性组血浆LPA、MMP-9水平均显著高于微栓子阴性组（t=42．57、16．61，均P=0．00）。LPA与MMP-9水平呈正相关（r=0．22，P：0．032）。结论LPA与MMP-9参与了脑梗死的病理生理过程，其与颈动脉斑块不稳定性密切相关。

Objective To investigate the correlation of plasma lysophosphatidic acid （LPA） and matrix metalloproteinase-9 （MMP 9） with carotid atheromatous plaque stability in patients with cerebral infarction. Methods The duplex ultrasonography and transcranial Doppler-detected microemboli were performed in the carotid arteries of all the 87 patients with cerebral infarction located in arteriae carotis interna system. The patients were divided into the intima thickening group （n=16）, unstable plaque group （n=41）, stable plaque group （n=21） and non-plaque group （n=9）. And there were 27 patients with positive microembolic signal and 60 patients with negative microembolic signal. The plasma levels of LPA and MMP-9 were determined by quantitative determination of inorganic phosphorus and enzyme-linked immunosorbent assay. Results The levels of LPA and MMP 9 were significantly higher in unstable plaque group than in the other three groups （F=49.98 and 106.49, both P〈0.01）, MMP-9 in intima thickening group and stable plaque group were both higher than in non-plaque group （q= 7.04 and 7.51, both P= 0.00）. LPA was higher in intima thickening group than in stable plaque group （q=7.37, P=0.00）, and higher in the above two groups than in non- plaque group （both P〈0.05）. The levels of LPA and MMP-9 were higher in microembolic signal- positive patients than in signal-negative patients （t= 42.57 and 16.61, both P=0. 00）. LPA level was positively correlated with MMP-9 （r=0.22, P〈0.05）. Conclusions LPA and MMP-9 may serve as a potential risk signal to hint the formation and rupture of unstable carotid atheromatous plaque which may cause ischemic cerebrovascular disease.