肝癌合并脑梗死32例临床分析  

A clinical study on 32 liver cancer patients with acute ischemic stroke

作　　者：韦馨娴 梁志坚[1] 秦超[1] 程道宾[1] 谢兴锐 张云利[1] 蔺心敬[2] 何宁宇[3] 

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]广西壮族自治区人民医院神经内科 [3]广西南宁市第二人民医院神经内科

出　　处：《中华肝胆外科杂志》2014年第6期414-417,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金项目（30860088,81260186）;广西自然科学基金项目（0832134,0991149）;广西教育厅科研项目（200710LX060）;广西医科大学博士启动基金（304214）

摘　　要：目的探讨肝癌合并脑梗死的临床特点及可能的发病机制。方法回顾性分析2005年1月至2012年12月，在住院接受肝癌治疗期间发生脑梗死以及住院接受急性脑梗死治疗期间证实患有肝癌患者的临床资料。结果共筛查原发性肝癌患者15795例，其中符合肝癌合并脑梗死入选标准者32例（0．20％）。入选患者中男26例（81．25％），女6例（18．75％），年龄27—68（45．63±11．01）岁。7例（21．87％）存在脑卒中危险因素，余25例（78．13％）无卒中危险因素。脑梗死发病急性期内，患者头颅MRI弥散成像（DWI）显示，脑内出现单一高信号病灶9例（28．12％），出现两个及以上不同动脉供血区高信号病灶23例（71．88％）。肝细胞癌27例（84．38％），胆管上皮癌5例（15．62％），其中有14例（43．75％）已经发生转移。血液生化检查显示外周血甲胎蛋白水平升高29例，D二聚体水平升高23例，癌抗原（CA）125水平升高21例、CA19-9水平升高17例。结论肝癌合并脑梗死患者大多数具有外周血D二聚体、甲胎蛋白及癌抗原水平升高、脑内出现多发性梗死灶等特点，其发生机制可能与患者血液凝固性升高有关。Objective To study the clinical features of liver cancer patients with acute ischemic stroke and to determine the pathogenesis of stroke. Methods The clinical data of in-hospital patients with liver cancer who developed acute ischemic stroke, including patients with liver cancer who developed acute ischemic stroke during anti-cancer therapies and those patients with acute ischemic stroke who were diagnosed to have liver cancer during anti-stroke therapies, from January 2005 to December 2012 were retrospectively reviewed. Results Of 15 795 patients with liver cancer, 32 （0. 20% ） developed acute ischemic stroke. There were 26 men （81.25%） and 6 women （18. 75% ）. Their age ranged from 27 to 68 years with a mean ＋/- S/D of 45.63 ± 11.01. Seven patients （21.87%） had some conventional cardiovascular risk factors, while the other 25 patients （ 78.13% ） had no such risk factors. Magnetic resonance imaging （MRI） scans at the acute stage of ischemic stroke were carried out for all these patients. Based on the diffusion weighted imaging （DWI） of MRI, 9 patients （28.12%） had one lesion and 23 patients （71. 88% ） had 2 or more lesions in different arterial territories in the brain. The subtypes of liver cancer were ： liver cell cancer （27 patients, 84. 38% ） , and intrahepatic cholangioearcinoma （5 patients, 15.62% ）. In 14 patients （43.75%） metastases were found. 29 patients had raised alpha fetal protein （AFP） levels, 23 patients had high D dimer levels, 21 patients had high cancer antigen （CA） 125 levels, and 17 patients had high CA19-9 levels. Conclusions Patients with liver cancer who developed acute ischemie stroke had distinct clinical features with high serum D dimmer, AFP and cancer antigen levels and multiple lesions in their brain. A hypereoagulabiiity state of blood may partially be responsible for the pathogenesis of ischemic stroke in these patients.

关 键 词：肝癌 脑梗死 临床特点 发病机制 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R735.7[医药卫生—临床医学]