Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Republic of Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Neurol Sci. 2017 Nov 15;382:116-121. doi: 10.1016/j.jns.2017.09.040. Epub 2017 Sep 30.
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.
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 2days after stroke onset). Acute ischemic lesions on diffusion-weighted imaging were measured in terms of size, composition, and pattern. Transthoracic echocardiography parameters were evaluated in all patients.
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.
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.
本研究旨在确定非动脉来源栓塞性卒中患者的游离脂肪酸（FFA）血浆水平是否与缺血性病变特征相关。
我们前瞻性招募了 254 例因心源性脑栓塞（CES，n=121）或不明来源栓塞性卒中（ESUS，n=133）引起的急性脑梗死患者。在急性发病期（卒中发病后 2 天的中位数）测量患者的 FFA 血浆水平。采用弥散加权成像评估急性缺血性病变的大小、组成和模式。对所有患者进行经胸超声心动图参数评估。
CES 和 ESUS 患者的 FAA 血浆水平无差异（mEq/L，0.78±0.52 比 0.67±0.61，P=0.120）。CES 患者的超声心动图参数（包括左心房容积指数和 E/e'）较高，且 CES 患者的缺血性病变体积较大。在 CES 和 ESUS 两组中，FFA 四分位间距升高与缺血性病变体积增加以及混合（小和大）和大皮质病变患者比例增加相关。多变量分析显示，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）与非动脉来源栓塞性卒中患者的缺血性病变体积相关。
无论是否存在高危心源性栓塞源，非动脉来源栓塞性卒中患者的 FFA 血浆水平升高与缺血性病变体积增大和大皮质梗死发生率增加相关。
