Trousseau综合征与心房颤动相关脑梗死的临床对比研究  

Clinical Comparative Study of Trousseau Syndrome and Atrial Fibrillation Associated Cerebral Infarction

作　　者：王立强 于金龙 李想[1] 何志义[1] WANG Li-qiang;YU Jin-long;LI Xiang;HE Zhi-yi(Department of Neurology,the First Affiliated Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属第一医院神经内科,沈阳110000

出　　处：《中国临床神经科学》2021年第5期533-542,共10页Chinese Journal of Clinical Neurosciences

摘　　要：目的提高临床Trousseau综合征(TS)与心房颤动(房颤)患者发生缺血性脑卒中的相关生化指标、临床表现、影像学特点及差异的认识。方法回顾性连续收集2019年1月至2021年1月中国医科大学附属第一医院神经内科收治的符合入选和排除标准的缺血性脑卒中患者111例。其中,27例合并恶性肿瘤并诊断为TS患者为TS组,84例合并房颤患者为房颤组。比较两组患者入院时的一般临床特征、血清学指标和影像学特点。结果TS组发病年龄低于房颤组(t=0.501,P<0.05);有冠心病病病史者少于房颤组(P<0.05)。TS组表现为部分前循环综合征(PACS)病例数明显多于房颤组(χ^(2)=250.60,P<0.01),TS组复合综合征的病例数多于房颤组(P<0.05)。TS组D-二聚体(t=3.709,P<0.01)和C反应蛋白(t=2.286,P<0.05)水平均高于房颤组。TS组MR-DWI梗死灶表现为Pattern 3(即多个点状播散性病灶)的比例高于房颤组(χ^(2)=6.655,P<0.05);TS组的前后循环受累病例多于房颤组(χ^(2)=4.1,P<0.05)。结论血浆D-二聚体和C反应蛋白水平升高是诊断TS并与房颤相关脑梗死鉴别的生物标志物,TS较房颤更易于形成多个小点状播散性梗死病灶,仅通过影像学检查难以鉴别两者。Aim To explore the biomarkers,clinical manifestations and neuroimaging characteristics in patients with Trousseau syndrome and atrial fibrillation.Methods This retrospective study enrolled consecutively adult patients with acute ischemic stroke admitted to our department from January 2019 to January 2021.The patients were divided into a Trousseau syndrome group(27 cases)and an atrial fibrillation group(84 cases).The general clinical features,initial symptoms,average hospitalization days,ICU admission rate,embolism at other sites,platelet count,serum D-dimer and C-reactive protein levels were compared between the two groups.Diffusion weighted imaging(DWI)showed the location,quantity and distribution pattern of infarct lesions.Results Compared with the control group,the age(t=0.501,P<0.05)and the history of coronary heart disease(P<0.05)in Trousseau syndrome group were lower than those in atrial fibrillation group.There was significant difference in clinical syndrome between the two groups.The proportion of PACS(partial anterior circulation syndrome)(χ^(2)=250.60,P<0.01)in Trousseau syndrome group was significantly higher than that in atrial fibrillation group,and the proportion of combined syndromes(P<0.05)in TS group was higher than that in atrial fibrillation group.Patients with Trousseau syndrome had significantly higher serum levels of D-dimer(t=3.709,P<0.01)and CRP(t=2.286,P<0.05)than those in atrial fibrillation group.In terms of the characteristics of DWI losions,the proportion of Pattern 3(multiple punctate disseminated lesions)in the Trousseau syndrome group was higher than that in atrial fibrillation group,and the proportion of anterior and posterior circulation involvement in the affected area in the Trousseau syndrome group was higher than that in atrial fibrillation group.Conclusion Elevated plasma D-dimer and CRP levels are useful biomarkers for the diagnosis of Trousseau syndrome and differentiate from atrial fibrillation-associated cerebral infarction.Trousseau syndrome is easier to form multiple

关 键 词：脑梗死 TROUSSEAU综合征 恶性肿瘤 心房颤动 磁共振弥散加权成像 

分 类 号：R743[医药卫生—神经病学与精神病学]