隐源性卒中合并隐匿性躯体恶性肿瘤患者D-二聚体的临床意义  

The clinical significance of plasma D-dimer levels in cryptogenic stroke with occult systemic malignancy patients

作　　者：郭琳佳[1] 刘文宏[1] 董健 杨帆[3] 虞峰[1] GUO Linjia;LIU Wenhong;DONG Jian;YANG Fan;YU Feng(Department of Neurology,Beijing Shijitan Hospital Affiliated with the Capital University Medical Sciences, Beijing 10038, China.)

机构地区：[1]首都医科大学附属北京世纪坛医院神经内科,北京100038 [2]首都医科大学附属北京世纪坛医院影像科 [3]北京丰台医院神经内科

出　　处：《中国神经精神疾病杂志》2018年第3期139-143,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨血浆D-二聚体水平和多支血管分布区脑梗死预测隐源性卒中合并隐匿性躯体恶性肿瘤(occult systemic malignancy,OSM)的临床价值。方法纳入83例隐源性卒中患者,合并OSM组9例,非合并OSM组74例,比较两组患者的临床资料。采用logistic回归方法分析高血浆D-二聚体水平和多支血管分布区脑梗死与OSM的相关性。结果单因素分析显示:与非OSM隐源性卒中患者相比,OSM组患者年龄偏大(66.8±7.5 vs.56.4±15.7,P=0.004),CONUT评分偏高[3(1,3)vs.1(0,2),P=0.011],血红蛋白偏低(127.9±19.8vs.143.6±17.7,P=0.015),高血浆D二聚体水平比例(77.7%vs.13.5%,P<0.001)及多支血管分布区脑梗死比例(100%vs.23.0%,P<0.001)明显升高。多因素Logistic回归分析:高血浆D-二聚体水平(OR=26.250,95%CI:3.041~226.604,P=0.003)是隐源性卒中患者合并OSM的独立预测因素。结论隐匿性卒中合并OSM患者的临床特点表现在年龄偏大、营养状态偏低、高血浆D-二聚体水平及脑梗死病灶常分布在多支血管供血区。高血浆D-二聚体水平有助于临床早期识别隐匿性卒中患者中的OSM。Objective This study aimed to investigate the clinical characteristics of cryptogenic stroke as the first manifestation of occult systemic malignancy（OSM） and to determine whether plasma D-dimer levels and lesions in multiple vascular regions could predict occult systemic malignancy in patients with cryptogenic stroke. Methods Data from 83 patients including 9 patients with OSM and 74 patients without OSM were extracted from the stroke database of Beijing Shijitan Hospital. Clinical variables were analyzed between cryptogenic stroke patients with OSM and without OSM. The relationshiop between plasma D-dimer levels or lesions in multiple vascular regions and OSM were analyzed by multiple logistic regression analysis. Results Compare to patients without OSM, patients with OSM was older（66.8±7.5 vs. 56.4±15.7, P=0.004） and had lower hemoglobin levels（127.9±19.8 vs. 143.6±17.7, P=0.015）, higher conut score[3（1,3） vs. 1（0,2）, P=0.011], higher plasma D-dimer levels（77.7% vs. 13.5%, P〈0.001） and more common lesions in multiple vascular regions（100% vs. 23.0%, P〈0.001）. Multiple logistic regression analysis revealed that high plasma Ddimer levels are independent risk factors for OSM（OR=26.250,95%CI： 3.041-226.604, P=0.003）. Conclusions Patients with OSM are elderly people and have poorer nutritional status, higher plasma D-dimer levels and more common lesions in multiple vascular regions. High plasma D-dimer levels can be useful to predict OSM in patients with cryptogenic stroke at earlier stages.

关 键 词：隐源性卒中 恶性肿瘤 D-二聚体 高凝状态 

分 类 号：R743[医药卫生—神经病学与精神病学] R73[医药卫生—临床医学]