肿瘤导致急性缺血性脑卒中临床发作机制研究  

The mechanism of acute ischemic stroke in cancer patients

作　　者：林佳才[1] 伍思婷 

机构地区：[1]解放军总医院海南分院神经内科,三亚572013

出　　处：《中国医师进修杂志》2016年第3期268-270,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的研究肿瘤导致急性缺血性脑卒中（AIS）临床发作机制。方法选取确诊肿瘤并发生AIS患者96例，将患者按TOAST分型进行分组，比较D-二聚体、影像学表现以及肿瘤部位等。结果肿瘤导致AIS患者中，以TOAST分型的原因不明缺血性卒中最多，占41．67％（40／96），然后分别为大动脉粥样硬化性卒中28例、心源性栓塞17例、小动脉闭塞或腔隙性卒中10例、其他原因所致卒中1例；而且以肺癌最多，占39．58％（38／96）。将肺癌按病理诊断分为鳞癌（18例）和腺癌（20例），腺癌患者原因不明所占比例明显高于鳞癌（2／18比15／20）。原因不明性缺血性卒中亚患者的影像学表现多样，可大致分为大动脉型、同流域型和颅内多灶型，其中以颅内多灶型多见，占52．50％（21／40）。大动脉粥样硬化性卒中、心源性栓塞、小动脉闭塞或腔隙性卒中、其他原因所致卒中以及不明原因缺血性卒中患者D．二聚体水平分别为（3．57±1．29）、（3．55±1．04）、（1．67±0．49）、1．52、（8．63±2．64）mg／L，均高于参考正常值上限（0．5mg／L），而且不明原因缺血性卒中患者D．二聚体水平显著高于其余各类型患者，差异有统计学意义（P〈0．01）。结论肿瘤患者发生AIS有其独特的发生机制，考虑与肿瘤导致的凝血功能异常密切相关，且随着肿瘤患者的不断增加，肿瘤相关性AIS意外有可能成为重要的卒中发生机制之一。Objective To analyze the mechanism of acute ischemic stroke in cancer patients. Methods The clinical TOAST type, laboratory examinations results, imaging examination results and pathology reports of the 96 patients with cancer and acute cerebral infarction were collected. Results According to TOAST mechanism, the main subtype was undetermined causes （41.67%, 40/96）. Lung cancer took largest proportion （39.58%, 38/96）. In the group of undetermined causes, adenocarcinoma was more common type than squamous. The imaging examination results could be classified into large artery type, large artery and small artery in same basin and multiple small arterys in different basins. We found the main type was multiple small arterys in different basins （52.50%, 21/40）. The lever of D-dimer was high in our patients, especially in undetermined causes （P 〈 0.01）. Conclusions Tumor-related acute cerebral infarction has its own uinque mechanism. Tumor is one kind of systemic diseases, which can promote thrombosis through increasing the lever of D-dimer. The cancer-related mechanism is the main mechanism underlying cancer-related stroke, and may become one of the most important mechanismsn in the pathogenesis of stroke in the near future.

关 键 词：肿瘤 脑血管障碍 TOAST分型 D-二聚体 

分 类 号：R743.3[医药卫生—神经病学与精神病学]