青年心脏黏液瘤患者并发卒中临床特点分析  

The clinical characteristics of stroke in young patients with cardiac myxoma

作　　者：曹贵方[1] 毕齐[1] 曹莉[1] 王超[1] 

机构地区：[1]首都医科大学附属北京安贞医院神经内科,100029

出　　处：《中华内科杂志》2017年第4期263-267,共5页Chinese Journal of Internal Medicine

摘　　要：目的探讨青年黏液瘤患者卒中发病的规律，为青年卒中的防治提供参考。方法回顾性分析2005年1月至2016年3月首都医科大学附属北京安贞医院收治的年龄为18-44岁的临床诊断为心脏黏液瘤患者的临床及影像学资料，分析并发卒中患者的临床特点。结果纳入117例患者，女85例，男32例，女／男为2．66：1，年龄（36±7）岁。黏液瘤分布：左心房98例（83．8％），右心房9例（7．7％），双侧心房4例（3．5％），左心室3例（2．6％），左心房并左心室2例（1．7％），右心室1例（0．9％）。24例（20．5％）患者并发缺血性卒中，其中3例缺血性卒中合并下肢动脉栓塞。2例并发出血性卒中。24例缺血性卒中患者中女16例（16／85，18．8％），男8例（8／32，25．0％），男女并发缺血性卒中的比例差异无统计学意义（X^2=0．725，P=0，395）。缺血性卒中主要累及颈内动脉分布区，4例患者同时累及2个及以上血管分布区。2例患者为复发性缺血性卒中。缺血性卒中临床表现以偏瘫最为多见（占58．3％），晕厥较多见（占18．2％）。并发缺血性卒中患者与不伴血管事件患者组间比较，性别、年龄、高血压、糖尿病、高脂血症和吸烟等危险因素的差异均无统计学意义，缺血性卒中组患者左心房黏液瘤所占比例显著高于不伴有血管事件的患者（100．0％比85．1％），P=0．044。缺血性卒中组患者肿瘤直径小于3em者9例（37．5％），其比例显著高于无血管事件组（13．8％），P=0．009；肿瘤直径小于3cm对于缺血性卒中的OR值为3．750，95％CI为1．343～10．470。结论青年心脏黏液瘤以女性多见，常并发卒中，其中以缺血性卒中为主，缺血性卒中累积区域以颈内动脉系统分布区为主，可同时累及多个血管分布区，卒中的发生与黏液瘤的部位有关，小体积黏液瘤易并发卒中，需要引�Objective To investigate the clinical characteristics of stroke in young patients with cardiac myxoma. Methods Medical records of young patients （ aged between 18 - 44 years） diagnosed with cardiac myxoma in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2005 to March 2016 were retrospective reviewed. Results A total of 117 cases were included （ 85 female and 32 male）with the average age （36±7）years old. Most myxomas （83.8%） were located in the left atrium, 7.7% were in the right atrium, 3.5% were in the both atriums, 2.6% were in the left ventricle, and a few were in the left atrium plus left ventricle and in the right ventricle. Of all the patients, 24 （20.5%） （16 women and 8 men） were complicated with cerebral infarction. Among them, 3 patients were with lower extremity arterial embolisms. Two patients were with cerebral hemorrhage. The cerebral infarction mainly involved in the distribution area of the internal carotid artery. Infarctions involving 2 or more cerebral vessels were found in 4 cases. Most subjects （58.3%） manifested with hemiplegia, and some （18.2%） with syncope. The proportion of the left atrial myxoma in patients with cerebral infarction （100. 0% ） was significantly higher than those in patients without cerebral infarction （ 85.1% , P = 0. 044 ）. Subjects with tumor diameter less than 3 cm were more frequently complicated with cerebral infarction （37.5% vs 13.8%, P = 0. 009）. A logistic analysis showed that the odds ratio of myxoma with tumor diameter less than 3 cm for cerebral infarction was 3. 750 （95 % C1 1. 343 - 10. 470）. Conclusions Cardiac myxoma is more common in young women, and often complicated with cerebral infarction. The infarctions are mainly distributed in internal carotid artery system, and some are involved in multiple vascular systems. The incidence of stroke is associated with the position of the myxoma. Smail-size myxoma cannot be ignored for its risk of stroke.

关 键 词：卒中 心脏黏液瘤 青年 

分 类 号：R732.1[医药卫生—肿瘤]