躯体恶性肿瘤合并脑梗死的临床特点  

Clinical characteristics of cerebral infarction in patients with systemic malignant tumor

作　　者：陈雅娟[1] 秦超[1] 梁志坚[1] 莫雪安[1] 赵伟佳[1] 石胜良[1] 王子军[1] 邓添薪[2] 

机构地区：[1]广西医科大学第一附属医院神经内科,南宁530021 [2]广西医科大学第一附属医院病案信息管理科,南宁530021

出　　处：《中华神经科杂志》2013年第7期465-469,共5页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目，广西自然科学基金资助项目，广西教育厅科研项目，广西医科大学博士启动基金资助项目

摘　　要：目的探讨恶性肿瘤患者脑梗死的临床特点及其可能的发病机制。方法连续收集2005年1月至2011年12月在广西医科大学第一附属医院接受躯体恶性肿瘤治疗，并在住院期间发生脑梗死的患者作为试验组（恶性肿瘤合并脑梗死组，STG）；同时分别选择性收录同期住院治疗的相同例数、年龄、性别相匹配的脑梗死患者作为单纯脑梗死组，以及相同例数、肿瘤类型、年龄、性别相匹配的恶性肿瘤患者作为单纯肿瘤组。结果共纳入符合条件的STG患者240例，同时分别选择性录入单纯脑梗死和单纯肿瘤组患者各240例。STG患者中肺癌是最常见的肿瘤类型85例（35．42％）。与单纯脑梗死组比较，试验组患者脑梗死病因不明者多见，MRI表现以累及多个动脉供血区的多个病灶为特点。与单纯肿瘤组比较，试验组患者恶性肿瘤发生转移或复发者多见。Logistic回归分析结果显示：血小板计数每升高1×10^9／L，恶性肿瘤患者发生脑梗死的概率升高约1．3％（OR=1．013，95％C11．005—1．022，P=0．002）。部分激活的凝血酶原时间每降低1s，肿瘤患者脑梗死风险增加15．4％（OR=0．846，95％C10．771—0．929，P=0．000）。采用过手术治疗的肿瘤患者发生脑梗死的危险性是未采用手术治疗的肿瘤患者的3．663倍（OR=3．663，95％CI 1．584—8．473，P=0．002）。结论恶性肿瘤合并脑梗死以缺少传统的危险因素、脑内出现多发性病灶为特点，恶性肿瘤患者血液凝固性升高是其可能的发生机制。Objective To investigate the clinical features of cerebral infarction in patients with systemic malignant tumor as well as its underlying mechanism. Methods The patients who receiving the treatment of cancer experiencing a new infarct at the acute phase in the first affiliated hospital from January 2005 to December 2011 were consecutively collected as experimental group （stroke and tumor group, STG）. At the same time, the patients without tumor experiencing a new infarct were consecutively collected as the stroke group matched with the experimental group on age, gender, and the patients who receiving the treatment of cancer without stroke were consecutively selected as the tumor group matched with the experimental group on age, gender and subtype of tumor. Results A total of 240 acute ischemic stroke patients with malignant tumor were enrolled. There were 22 kinds of tumor involved, in which lung cancer was the most common type, accounting for 35.42% （85/240）. Compared with the stroke group, the STG had a brain magnetic resonance imaging （MRI） features with multiple lesions in more than one artery territory, and had more patients with cryptogenic stroke. Compared with the tumor group, the STG had more patients with metastasis tumor. Multiple logistic regression analysis revealed that while platelet count increased by 1× 10^9/L, the probability of cerebral infarction in patient with malignant tumor would increase by about 1.3% （ OR = 1. 013,95% CI 1. 005--1. 022, P = 0. 002 ）. The elongation of activated partial thromboplastin time played a protective role for stroke in patients with malignant tumor, and 1 s of its reducing caused the possibility of increasing cerebral infarction by 15.4% （ OR = 0. 846,95% CI0. 771--0. 929, P = 0. 000）. The risk of cerebral infarction in tumor patients who had received surgical treatment was 3. 663 times more than the cancer patients who did not receive it （ OR = 3. 663, 95% CI 1. 584--8. 473, P = 0. 002）. Conclusions Compared with the stroke patients with

关 键 词：肿瘤 脑梗死 危险因素 血液凝固 LOGISTIC模型 

分 类 号：R-05[医药卫生]