常保强 马令秋

[摘要]目的 探討丁苯酞对急性分水岭脑梗死（CWI）患者血浆溶血磷脂酸（LPA）水平的影响及其近期疗效。方法 选取2015年1月～2016年12月我院收治的的106例CWI患者作为研究对象，按照随机数字表法分为丁苯酞组和常规治疗组，每组各53例。选取同期健康体检者50例作为对照组。常规治疗组给予抗血小板等常规治疗，丁苯酞组在常规治疗组基础上于发病后48 h内加用丁苯酞注射液100 ml，静脉滴注2次/d，共14 d。分别于治疗前及治疗后7 d、14 d检测血浆LPA水平并比较NIHSS评分。结果 丁苯酞组、常规治疗组治疗前的血浆LPA水平高于对照组，差异有统计学意义（P<0.01）；丁苯酞组治疗后7 d的血浆LPA水平高于常规治疗组，差异有统计学意义（P<0.05）；三组治疗后14 d的血浆LPA水平比较，差异无统计学意义（P>0.05）；丁苯酞组、常规治疗组治疗后14 d的NIHSS评分均高于治疗前，差异有统计学意义（P<0.01），且丁苯酞组治疗后14 d的NIHSS评分均高于常规治疗组（P<0.05）；丁苯酞组治疗后14 d的有效率、显效率均高于对照组，差异有统计学意义（P<0.05）。结论 CWI患者早期血浆LPA水平显著升高，提示其体内血小板处于活化状态，在常规治疗基础上应用丁苯酞治疗可降低LPA水平，可以减少患者的神经功能缺损。

[关键词]分水岭脑梗死；丁苯酞；溶血磷脂酸

[中图分类号] R543 [文献标识码] A [文章编号] 1674-4721（2018）7（a）-0073-04

[Abstract]Objective To explore the effect of Butylphthalide on plasma lysophosphatidic acid （LPA） level for acute watershed infarction （CWI） and its short-term treatment efficacy.Methods From January 2015 to December 2016，106 patients with CWI were selected as the subject，and devided into the routine treatment group and Butylphthalide group by random number table method，with 53 cases in each group.A total of 50 healthy subjects were selected as the control group.The routine treatment group was treated with conventional antiplatelet therapy.The Butylphthalide group was treated with the same routine procedure，within 48 h after the onset of the disease，the patients were given Butylphthalide injection 100 ml by intravenous drip times a day after operation for 14 d.Plasma lysophosphatidic acid （LPA） level was measured before and after treatment at 7 and 14 d，and the NIHSS scores were compared.Results The plasma LPA level in the routine treatment group and Butylphthalide group were significantly higher than that in control group （P<0.01）.The plasma LPA level in the Butylphthalide group was significantly higher than that in the routine treatment group at 7 d after treatment （P<0.05）.There was no significant difference in plasma LPA level among the three groups at 14 d after treatment （P>0.05）.The NIHSS scores of the butylphthalide group and routine treatment group at 14 d after treatment were higher than before （P<0.01），and the NIHSS scores of the Butylphthalide group was significantly higher than that in the routine treatment group （P<0.05）.The effective rate and obvious effective rate at 14 d after treatment in Butylphthalide group was higher than those in control group，the differences were statistically significant （P<0.05）.Conclusion The level of plasma LPA in the early stage of acute CWI in patients improves，suggesting that the platelet is activated in vivo.The application of Butylphthalide on the basis of routine therapy can decrease the level of plasma lysophosphatidic acid and reduce the neurologic impairment.

[Key words]Watershed cerebral infarction；Butyphthalide；Lysophosphatidic acid

分水岭脑梗死（cerebral watershed infarction，CWI）是脑内相邻两条及以上动脉供血区间的交界区或边缘带发生的脑梗死，约占全部脑梗死的10%，易进展加重，致死率和致残率较高，是脑梗死治疗的重点和难点之一，目前认为血流动力学障碍和动脉-动脉栓塞可能是其主要发病机制[1-2]。丁苯酞是治疗急性缺血性脑血管病的国家I类新药，已在治疗CWI方面取得较好效果，主要通过改善缺血区侧枝循环、保护线粒体功能及微血管内皮完整性发挥良好作用[3]，但CWI进展加重的病理生理学机制尚不明确，有学者指出血小板活化可能在急性分水岭脑梗死患者疾病进展中起重要作用[4]。血浆溶血磷脂酸（lysophosphatidic acid，LPA）是血小板活化的生化标记物[5]，是缺血性脑卒中血栓形成的研究热点。……