纤溶酶原激活物抑制物-1与急性脑梗死并发急性肺损伤/急性呼吸窘迫综合征的相关性研究

目的探讨急性脑梗死并发急性肺损伤/急性呼吸窘迫综合征患者血清纤溶酶原激活物抑制物-1(PAI-1)水平变化及临床意义。方法采用前瞻性研究方法,收集急性脑梗死并发ALI/ARDS患者28例,单纯ALI/ARDS患者26例,健康对照组20例。根据脑梗死部位不同,A组被进一步分为前循环区组(5例)、后循环区组(15例)、分水岭区组(8例)。所有研究对象均已行头颅CT/MRI检查。A、B组行APACHEⅡ评分。检测所有患者血清PAI-1水平,比较各组PAI-1水平变化及其与A-PACHEⅡ评分相关性。结果脑梗死并发ALI/ARDS组、单纯ALI/ARDS组PAI-1水平高于对照组(P<0.01),脑梗死并发ALI/ARDS组高于单纯ALI/ARDS组(P<0.05)。后循环梗死患者ALI/ARDS发生率最高(53.57%)。血清PAI-1水平与A-PACHEⅡ评分呈正相关(P<0.01)。结论 ALI/ARDS存在凝血纤溶功能障碍,脑梗死(尤其后循环区梗死)更易致ALI/ARDS的发生,PA-I1水平可预示疾病的严重程度。

Research on correlation between complicated acute lung injury/acute respiratory distress syndrome and plasminogen activator inhibitor-1 in patients with acute cerebral infarction

Objective To explore the changes and clinical significance of serum plasminogen activator inhibitor 1(PAI-1) in cerebral infarction patients with acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods A prospective research method was performed.28 cerebral infarction patients with ALI and ARDS were selected,26 patients with ALI or ARDS were included,20 healthy people were collected as control group.According to different areas of cerebral infarction,group A was further divided into three groups: anterior circulation area(5 cases),posterior circulation area(15 cases) and watershed area(8 cases).All patients had skull CT/MRI examination.APACHE Ⅱ score was estimated in groups A and B.PAI-1 level in all patients was detected,and the variations of PAI-1 level in each group and its relativity to APACHE Ⅱ score were compared.Results PAI-1 levels in cerebral infarction group complicated with ALI/ARDS and simple ALI or ARDS group were higher than control group(P<0.01),and cerebral infarction group complicated with ALI/ARDS was higher than simple ALI or ARDS group(P<0.05).The incidence rate of ALI/ARDS in patients with infarction in posterior circulation area was the highest(53.57%).A positive correlation was found between PAI-1 level and APACHE Ⅱ score(P<0.01).Conclusion Disturbance of coagulation and fibronolysis system is present in ALI/ARDS.Cerebral infarction,especially in posterior circulation area,are more likely to lead to the occurrence of ALI/ARDS,and PAI-1 level can reflect the seriousness of disease.