躯体恶性肿瘤合并脑出血的发病特点  

Clinical characteristics of acute cerebral hemorrhage in patients with systemic malignancy

作　　者：黄戈伦 秦超[1] 梁志坚[1] 程道宾[1] 陈莉[1] 卢秋红[1] 虞丽霞 

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]病案管理科

出　　处：《中华医学杂志》2016年第17期1336-1340,共5页National Medical Journal of China

基　　金：国家自然科学基金（30860088,81260186）;广西自然科学基金（0832134,0991149）

摘　　要：目的探讨躯体恶性肿瘤合并脑出血患者的临床特点和可能的发病机制。方法回顾性研究2003年1月至2014年12月在广西医科大学第一附属医院住院治疗的躯体恶性肿瘤合并脑出血患者的临床表现、实验室检查及影像学检查等临床资料。结果本研究共筛查61326恶性肿瘤患者，符合躯体恶性肿瘤合并脑出血25例（0．04％），男18例，年龄31—77岁，平均（62±12）岁。入选患者的脑出血临床特点包括多数患者（14例，54．0％）缺少传统脑出血危险因素，所有患者均为急性起病，均有不同程度的言语不清、肢体乏力等局灶性神经功能缺失的症状和体征，出血部位以大脑半球多见（19例，76．0％），多数患者（15例，60．0％）在确诊躯体恶性肿瘤后3d至3年内出现脑出血，部分患者（8例，32．0％）以脑出血为首发表现而人院治疗，期间被证实患有躯体恶性肿瘤；恶性肿瘤的类型以肺癌最多（8例，32．00％），其次是肝癌（7例，28．0％），然后是胃癌（6例，24．0％）；多数患者（22例，88．0％）血浆出现一项或多项肿瘤标志物[包括癌抗原CA125、199、153，癌胚抗原（CEA），甲胎蛋白（AFP）等]升高，多数患者（16例，64．0％）出现凝血功能障碍。结论躯体恶性肿瘤合并脑出血以多数患者缺少脑出血的传统危险因素，出血部位常累及大脑半球，多数患者出现凝血功能障碍、外周血肿瘤标志物升高等为特点，其发生机制可能与患者凝血功能障碍有关。Objective To investigate the clinical features of systemic malignancy patients with acute cerebral hemorrhage as well as its underlying mechanism. Methods The clinical data, including presentation, lab tests and neurological images, of systemic malignancy patients with acute cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University between January 2003 and December 2014 were collected and analyzed. Results Among 61 326 systemic malignancy patients, 25 patients（0.04% ）were found with acute cerebral hemorrhage and were enrolled. Out of these 25 patients, age ranged from 31 to77 years old, with an average age of 61 years, 18 patients were males. The clinical features of the systemic malignancy patients with acute cerebral hemorrhage were found that most patients （ 14/25, 54.0% ） lacked traditional risk factors, with sudden symptom onset and some degree of neurologic deficiency in all patients, and most hemorrhagic lesions （19/25, 76.0% ） involved the hemicerebrum, for most patients （ 16/25, 60.0% ） cerebral hemorrhage occurred after 3 days to 3 years of the malignancy diagnosis, and some malignancy patients （ 8/25, 32.0% ） presented with cerebral hemorrhage as the first presentation. The common subtypes of malignancy found were lung cancer （ 8/25, 32.0% ） , liver cancer （7/25, 28.0%）, and then gastric carcinoma （6/25, 24.0%）. Most patients （22/25, 88.0%） had elevated plasma level of cancer biochemical marks （ including one or more than one of cancer antigen 125, 153 and 199, eareino-embryonic antigen, and alpha fetal protein）, most patients （16/25, 64.0% ） were found to have coagulation disorder. Conclusions The unique clinical features of the systemic malignancy patients with acute cerebral hemorrhage are most patients lacking traditional risk factors, with coagulation disorder and with hemorrhagic lesions in hemieerebrum. And coagulation disorder might be responsible for the cerebral hemorrhage.

关 键 词：恶性肿瘤 脑出血 临床特点 发病机制 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R739.9[医药卫生—临床医学]