以急性脑梗死为首发表现的恶性肿瘤患者临床特点探讨  

CLINICAL FEATURE OF ISCHEMIC STROKE AS THE INITIAL MANIFESTATION IN PATIENTS WITH SYSTEMATIC MALIGNANCY

作　　者：张云利[1] 秦超[1] 梁志坚[1] 莫雪安[1] 程道宾[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：《广西医科大学学报》2014年第6期929-931,共3页Journal of Guangxi Medical University

基　　金：国家自然科学基金资助项目(No.30860088;81260186);广西自然科学基金资助项目(No.0832134;0991149);广西教育厅科研项目(No.200710LX060);广西医科大学博士启动基金(No.304214)

摘　　要：目的：探讨以急性脑梗死起病的恶性肿瘤的临床特点,探讨恶性肿瘤以急性脑梗死为首发表现的发病机制.方法：收集我院2005年1月至2012年12月以急性脑梗死住院治疗,年龄≥18岁,既往无肿瘤病史,在住院期间被确诊为非颅内恶性肿瘤患者的临床资料.结果：本组符合条件的患者26例,其中男1 9例,女7例,年龄24～55岁,平均（39.42±8.05）岁.所有患者起病前无不适,均以一侧肢体无力、麻木或言语不清等表现急性起病.多数患者无传统的脑卒中危险因素（19例,73.08％）、外周血D-二聚体水平升高（16例,61.54％）,肿瘤抗原（canceragent,CA） 125升高（19例,73.08％）、CA199升高（20例,76.92％）,脑内出现多动脉供血区多发性梗死灶（20例,76.92％）.肿瘤的类型以肺癌（12例,46.15％）最多见,然后是原发性肝癌（5例,19.23％）.多数患者预后不良（mRS：2～5分）7例（26.92％）,死亡8例（30.77％）.结论：以急性脑梗死为首发表现的恶性肿瘤患者常缺乏传统的脑卒中危险因素、其外周血D-二聚体水平及肿瘤抗原水平升高,以及脑内出现多发性脑梗死灶,血液的凝固性升高可能与脑梗死的发病有关.Objective：To investigate the clinical features of ischemic stroke as the initial manifestation in patients with systemic malignancy.Methods：The clinical data of patients with ischemic stroke in the first affiliated hospital of Guangxi medical university,and within the period when receiving treatment were firstly demonstrated with no intracranial malignancy,were consecutively enrolled from January 2005 to December 2012.Results：Twenty six patients,with age from twenty four to fifty fine and mean age（39.42±8.05）year old,were enrolled,and of them nineteen cases were men and seven cases were women.All patients under went a blunt attack with manifestations of hemiplegic paralysis,hemiplegic paralysis and without any symptoms before the mentioned symptoms.Most patients had not conventional vascular risk（19 cases,73.08％）,with a higher D dimer level（16 cases,61.54％）,a higher cancer agent （CA） 125 level（19 cases,73.08％） andahigherCA199 level（20 cases,76.92％）inexternalblood.And most patients had more than two ischemic lesions in their brain with poor prognosis.Among the involved types of malignancy,lung cancer counting twelve cases （46.15％） was at the first,and then was followed by liver cancer（5 cases,19.23％）.Conclusion：It was suggested that the systemic malignancy patients with ischemic stroke as the initial manifestation tended to have instinct clinical features including without vascular risks,with higher levels of D-dimer,CA125 and CA199 in external blood and with two or more lesions in the brain.Coagulopathy may be partially responsible for the mechanism which resulted in cerebral infarction in these patients.

关 键 词：脑梗死 恶性肿瘤 临床特点 

分 类 号：R743.33[医药卫生—神经病学与精神病学]