Free fatty acid as a determinant of ischemic lesion volume in nonarterial-origin embolic stroke
Free fatty acid as a determinant of ischemic lesion volume in nonarterial-origin embolic stroke
复制标题
DOI：
10.1016/j.jns.2017.09.040
复制
发表时间：
2017-11-15
影响因子：
4.4
通讯作者：
Bang, Oh Young
中科院分区：
文献类型：
--
作者：
Chung, Jong-Won;Seo, Woo-Keun;Bang, Oh Young
目的：本研究旨在确定血浆游离脂肪酸（FFA）水平是否与非动脉源性栓塞性卒中的缺血性病变特征相关。材料和方法：我们前瞻性地招募254例心源性卒中（CES, n = 121）或来源不明的栓塞性卒中（ESUS, n = 133）引起的急性脑梗死患者。在急性期（中位时间为中风发作后2天）测量血浆游离脂肪酸水平。在弥散加权成像上测量急性缺血性病变的大小、组成和模式。评估所有患者的经胸超声心动图参数。结果：CES和ESUS患者血浆FAA水平无差异（mEq/L, 0.78 +/- 0.52 vs. 0.67 +/- 0.61, P = 0.120）。超声心动图参数包括左心房容积指数和E/ E′均高于ESUS患者，且CES患者的缺血性病变体积大于ESUS患者。在FFA四分位数中，CES组和ESUS组的缺血性病变体积和混合性（大、小）和大皮质病变的患者比例均增加。在多变量分析中，FFA水平（系数5.249，标准误差3.447,P = 0.001）、心房颤动（系数7.673，标准误差1.855,P < 0.001）和空腹血糖（系数0.104，标准误差0.023,P < 0.001）与非动脉源性栓塞性卒中的缺血性病变体积相关。结论：血浆FFA水平升高与非动脉源性栓塞性卒中患者更大的缺血性病变体积和更高的大面积皮质梗死发生率相关，无论是否存在高危心源性栓塞。
Goals: This study aimed to determine whether the plasma levels of free fatty acid (FFA) are associated with ischemic lesion characteristics in nonarterial-origin embolic stroke.Materials and methods: We prospectively recruited 254 patients with acute cerebral infarction caused by cardioembolic stroke (CES, n = 121) or with embolic stroke of undetermined source (ESUS, n = 133). Plasma levels of FFA were measured during the acute stage (median of 2 days after stroke onset). Acute ischemic lesions on diffusion-weighted imaging were measured in terms of size, composition, and pattern. Transthoracic echo-cardiography parameters were evaluated in all patients.Findings: Plasma levels of FAA were not different in CES and ESUS patients (mEq/L, 0.78 +/- 0.52 vs. 0.67 +/- 0.61, P = 0.120). Echocardiography parameters, including left atrium volume index and E/e', were higher, and the ischemic lesion volume was larger in patients with CES than in those with ESUS. The ischemic lesion volume and the proportion of patients with mixed (small and large) and large cortical lesions increased with FFA quartile in both CES and ESUS groups. In a multivariable analysis, FFA level (coefficient, 5.249; standard error, 3.447; P = 0.001), atrial fibrillation (coefficient, 7.673; standard error, 1.855; P < 0.001), and fasting glucose (coefficient, 0.104; standard error, 0.023; P < 0.001) were associated with ischemic lesion volume in nonarterial-origin embolic stroke.Conclusion: Elevated plasma FFA levels are associated with larger ischemic lesion volumes and a higher prevalence of large cortical infarcts in patients with nonarterial-origin embolic stroke regardless of the presence of a high-risk cardioembolic source.