非神经系统恶性肿瘤并发急性缺血性卒中临床特征分析

Clinical characteristic analysis of non-nervous system malignancy-related acute ischemic stroke

目的评价非神经系统恶性肿瘤并发急性缺血性卒中的临床特征及治疗。方法连续纳人军事医学科学院附属医院神经内科2011年5月-2013年6月非神经系统恶性肿瘤并发急性缺血性卒中患者30例为肿瘤组，选取年龄、性别匹配的30例非肿瘤相关急性缺血性卒中患者为非肿瘤组。收集两组的临床资料进行统计学分析。结果①两组传统卒中危险因素比较显示，肿瘤组高血压所占比率为40．0％（12／30），低于非肿瘤组的70．0％（21／30）；肿瘤组吸烟、饮酒、高血压、冠心病、糖尿病卒中高危因素均无的患者所占比率为40．0％（12／30），高于非肿瘤组的13．3％（4／30），差异均有统计学意义，P〈0．05。②实验室检查显示，肿瘤组患者血红蛋白、血小板计数、总胆固醇及低密度脂蛋白胆固醇水平均低于非肿瘤组，P〈0．05或P〈0．01；D一二聚体水平高于非肿瘤组，分别为1．7（0．10—6．67）和0．45（0．02～6．34）mg／L，P〈0．01。③肿瘤组63．3％（19／30）的患者脑梗死病灶为双侧半球分布，非肿瘤组患者70．0％（21／30）为单侧半球分布，差异有统计学意义，P〈0．01；肿瘤组70．0％（21／30）为多发病灶，而非肿瘤组63．3％（19／30）为单发病灶，P〈0．01。结论肿瘤相关急性缺血性卒中与非肿瘤缺血性卒中患者的病因可能不同。血液的高凝状态导致的血栓形成可能是造成卒中的重要原因之一。

Objective To evaluate the clinical characteristics and treatment of patients with non nervous system malignancy related acute ischemie stroke. Methods Thirty consecutive patients with non-nervous system malignancy and complicated with acute isehemic stroke at the Department of Neurology, the Affiliated Hospital of Academy of Military Medical Sciences from 2011 May to 2013 June were used as a malignant group. Thirty age- and sex-matched patients with acute ischemic stroke but without tumor were selected as the control group. The clinical data of both groups were collected and analyzed statistically. Results ①Comparing the traditional risk factors for stroke between the two groups, the percentage of hypertension in the malignant group was 40% （ 12/30）, and it was less than 70.0% （21/30） in the control group. The percentage of the patients without high risk factors for stroke such as smoking history, drinking history, hypertension, coronary heart disease, and diabetes was 40% （12/30） in the malignant group, and it was higher than 13.3% （4/30） in control group. There was significant difference （P 〈 0.05）. ②Laboratory examination revealed that hemoglobin, platelet count, total cholesterol and low density lipoprotein cholesterol levels in the malignant group were lower than those inthe control group （P 〈 0.05 or P 〈 0.01 ）. The D-dimer levels were higher than those in the control group, they were 1.7 （ O. 10 - 6.67 ） and 0.45 （ 0.02 - 6.34 ） mg/L, respectively （ P 〈 0.01 ）. ③Cerebral infarction lesions of 63.3% patients in the malignant group were bilateral hemispheric distribution, and 70.0% （21/30） in the control group were unilateral hemispheric distribution. There was significant difference （P 〈0.01） ; 70% of the lesions in the control group were multiple lesions, while 63.3 % of the lesions in the control group were single lesion （ P 〈 0.01 ）. Conclusion The etiology of patients with malignancy-related acute cerebral infarction and non-malignancy-related ischemic stroke may be different. Blood hypercoagulability caused thrombosis may be one of the important causes.