Clinical Significance Of Plasma LPA In Patients With Progressive Cerebral Infarction

Ischemic cerebral disease is kind of frequently encountered and severe disease with high mortality and disability rate. It put heavy burden on patients'family and the society. Progressive cerebral infarction is a special type of cerebral infarction. It often result irreversible neurological dysfunction and its fatality rate is higher than common cerebral infarction. Progressive cerebral infarction includes cases where the neurologic dysfunction increases gradually or patient's condition aggravate by therapy in 6 hours-1 week after onset, whose incidence rate is about 16-46% in stroke. Some research display fatality rate of common cerebral infarction is 8.6% whereas progressive cerebral infarction's is 35%. Aggravated neurologic dysfunction leads to mortality increases more than four times. Wherefore, we should strengthen cognition of progressive cerebral infarction in the course of ischemic cerebral disease prevent and cure. Make it possible to early diagnosis, forecast neurologic dysfunction aggravat and cure after onset.Lysophosphatidic acid (LPA) is a kind of cell membrane lipoid ramification. It is small molecule lipide bring by cell membrane during phospholipid synthesis and have many biological function activity. 90% LPA come from activated thrombocyte. LPA make thrombocyte accumulate through positive feedback. This result in blood coagulation system accentuation and possible thrombose ultimum. Owing to plasma LPA is substance released by thrombocyte in earlier period of blood clotting and thrombosis, wherefore LPA may be a molecule label which indicate priming of blood clotting and thrombosis in vivo. AP is a sort of ischemia marker which appear within ischemia 24 hour. Its higher level indicate cerebral ischemia of patient. That is cerebral ischemia result in oxyradical delivery, phosphatidic acid enzyme activity accrescence and the AP level heighten. Recent research indicate LPA have a close relation with ischemic cerebral disease, but there isn't any report about the relationshipbetween LPA, AP and progressive cerebral infarction.The research analysis the risk factors of progressive cerebral infarction and measure plasma LPA, AP, at the same time, observate the change of LPA, AP in patients with different parts, volumes, degrees of infarction. We make approach for relationship between LPA, AP with progressive cerebral infarction and then offer theoretical foundation for early diagnosis, forecast neurologic dysfunction aggravat and evaluate prognosis of progressive cerebral infarction.We choose 76 patients with infarction of the cerebral median artery (including 30 with progressive cerebral infarction and 46 with non-progressive cerebral infarction), whose onset duration were within 24 hours, and 20 normal control from 2006.9-2007.3 at the department of neurology and policlinic in China Japan Union Hospital of Jilin University, all patients accord with the diagnostic standard of the national fourth Meeting of cerebrovascular disease in 1996. These detects were done in all cerebral infarction case: Blood sugar by glucose oxidase method,blood lipids by enzyme, FIB by turbidimetric method, plasm concentration of LPA and AP was detected by assaying its phosphorous component; such as smoking, drinking, hypertension, diabetes and coronary artery disease, were also recorded. CSS was used to make score about the degree of nervous system functional impairment of cerebral infarction. The volum of infarction was measured by Pullicino formula. Correlation between the plasm concentration of LPA/AP and progressive cerebral infarction was analysed. The result shows that diabetes, repeat TIA spasm and blood sugar in progressive cerebral infarction group were all higher than the non-progressive cerebral infarction group; Plasm concentration of LPA/AP in the cerebral infarction group were higher than the controlled group. There were significant difference in the plasm concentration of LPA/AP between progressive cerebral infarction group and non-progressive cerebral infarction group. The bigger infarction volume is, the more plasm concentration of LPA/AP. LPA/AP in light, medium,severe groups increases successively. No obvious difference is observed among LPA/AP level of different parts. Correlation analysis shows, LPA and AP is correlated with infarction volume and CSS positively.There are many report about risk factors of progressive cerebral infarction, but the exact pathogenesy is not fully distinct. The research analysis the risk factors and laboratory index of progressive cerebral infarction and measure plasma LPA and AP. The result shows, diabetes, repeat TIA spasm and blood sugar in progressive cerebral infarction group were all higher than the non-progressive cerebral infarction group and LPA/AP in different group have significantly change. It indicates that there is a notable relationship between these factors and progressive cerebral infarction. Multivariable logistic regression showed the raising of plasma LPA and AP may be the risk factors of progressive cerebral infarction.We used CSS to make score about the degree of nervous system functional impairment of progressive cerebral infarction and divided patients into light, medium, severe groups. The volum of infarction was measured by Pullicino formula. Comparison of plasma LPA and AP have been done between different infarction volume, location and CSS score. The results show that in the early stage of progressive cerebral infarction, LPA is increasing sharply. The more the volume and CSS of progressive cerebral infarction are, the higher LPA and AP rises. Correlation analysis shows, LPA and AP is correlated with infarction volume and CSS score positively. It indicate the degree of platelets activate is high in the early stage of cerebral infarction. The higher the LPA rises, the higher the degree of platelets activate will be. So as a molecular marker LPA can reflect platelets activate and thrombus progression. It need some time from thrombocyte be activated to infarction appear. If we detect LPA and AP regular for people who have risk factors of cerebrovascular disease, when the index level raising we have chance to stabilize the plaque and reduce ischemic accident. This is important to prevent and cure cerebrovascular disease.In summary, through analysising the risk factors and laboratory index of progressive cerebral infarction and measure plasma LPA and AP, we could made this conclusion: diabetes, repeat TIA spasm, blood sugar, plasm concentration of LPA and AP in progressive cerebral infarction group were all higher than the non-progressive cerebral infarction group. Multivariable logistic regression showed the raising of plasma LPA and AP may be the risk factors of progressive cerebral infarction. LPA is increasing sharply in the early stage of progressive cerebral infarction, the more the volume and CSS of progressive cerebral infarction are, the higher LPA and AP rises. LPA can reflect platelets activate and thrombus progression as a molecular marker. Correlation analysis shows, LPA and AP is correlated with infarction volume and CSS score positively. Thrombogenesis is the main pathogenesy of progressive cerebral infarction. LPA is warning factor and AP is ischemic marker, the two indexes may be valuable in diagnosis and cure of progressive cerebral infarction.