ITP并发脑梗死13例临床分析

ITP with cerebral infarction: clinical analysis of 13 cases

目的分析特发性血小板减少性紫癜(ITP)并发脑梗死的临床特点,提高对ITP合并脑梗死的诊治水平。方法回顾性分析13例ITP并发脑梗死患者的临床资料,包括一般情况、临床表现、脑梗死危险因素、辅助检查、治疗及转归等。结果 13例患者年龄(57.8±15.2)岁,11例存在高龄、吸烟、高血压病、糖尿病、服用糖皮质激素史、血脂异常等脑梗死危险因素及自身抗体谱阳性、抗磷脂抗体异常等;11例存在与影像学检查所提示脑梗死部位相应临床表现,MRI显示脑梗死类型2例为大面积脑梗死、3例为腔隙性脑梗死、8例为多发性脑梗死,梗死病灶不规则,可同时出现双侧病灶。13例在治疗ITP的基础上(主要应用糖皮质激素及静脉丙种球蛋白)按患者情况治疗脑梗死,所有患者好转或情况稳定。结论 ITP合并脑梗死发病机制除与常见脑梗死危险因素有关外,可能与自身免疫性血管炎有关,此类患者影像学示脑梗死病灶不规则,应用糖皮质激素及静脉丙种球蛋白治疗有较好的效果。

Objective To analyze the clinical characteristics of idiopathic thrombocytopenic purpura （ITP） with cerebral infarction, and to improve the treatments of the ITP with cerebral infarction. Methods Retrospective analysis the clinical features of 13 patients who had the ITP with cerebral infarction, including the general situation, the clinical manifestation, risk factors of cerebral infarction, auxiliary examination, treatment and outcome, etc. Results In this group, the patients aged （57. 8 ＋ 15.2） years old, 11 cases have the risk of cerebral infarction such as advanced age, smoking, hypertension, diabetes, taking glucocorticoids, dyslipi- demia and autoantibody spectrum positive, resistance of phospholipid antibody abnormalities, etc. Another 11 cases were suggested that cerebral infarction consistent with clinical performance in imaging examination, MRI showed that cerebral infarction types have massive cerebral infarction （2cases） , lacunar cerebral infarction （3cases） , multiple cerebral infarction （8cases）. In multiple cerebral infarction, the lesions were irregular and two sides sometimes. All the patients became better after treating cerebral infarction basing on treating ITP. Conclusions Image changes of ITP with cerebral infarction are different from the atherosclerosis vascular le- sions of cerebral, the infarction is irregular and it may occur bilaterally at the same time, it should be paid at- tention to identify, in addition to common risk factors, the patbogenesis of cerebral infarction may associated with autoinnnune vaseulitis, the application of glucoeurticoid and intravenous gamma globulin on the treatment have better effect.