鼻咽癌合并脑梗死十例临床分析

Clinical features of ischemic stroke in patients with nasopharyngeal carcinoma

目的 探讨鼻咽癌合并脑梗死患者的临床特点.方法 回顾性分析2006年1月至2013年12月在广西医科大学第一附属医院住院治疗的鼻咽癌合并脑梗死患者的临床表现、实验室检查以及影像学检查等临床资料,分析总结其临床特点及可能的发病机制.结果 本研究共纳入鼻咽癌患者3 822例,其中符合鼻咽癌合并脑梗死入组标准的10例（0.262％）,均为男性;年龄39～70岁,平均51岁.10例鼻咽癌均为鳞状细胞癌,其中7例已发生转移.10例患者中3例存在1种以上传统脑梗死危险因素,7例无传统脑梗死危险因素.在脑梗死急性期内行头颅MRI平扫、弥散加权（diffusion weighted imaging,DWI）检查发现,脑内仅有单一病灶者2例;分布在2个及以上动脉供血区且有2个及以上病灶者8例.血液学检查发现,7例患者血液中D-二聚体水平不同程度升高.结论 鼻咽癌合并脑梗死患者多缺乏传统脑梗死危险因素;外周血D-二聚体水平升高;一次发病出现累及多个动脉供血区的多发性梗死灶可能是其主要临床特点。

Objective To investigate the clinical features of ischemic stroke in patients with nasopharyngeal carcinoma.Methods The clinical data of the nasopharyngeal carcinoma patients with ischemic stroke treated at the First Affiliated Hospital of Guangxi Medical University between January 2006 and December 2013 were collected.Results Among 3 822 patients with nasopharyngeal carcinoma l0 patients suffered from acute ischemic stroke.The 10 patients were males and their age ranged from 39 to 70 years old,with an average age of 51 years.All of the patients were found with squamous cell carcinoma,with metastasis in 7 of them.Among the 10 patients,only 3 patients had with traditional risk factors for ischemic stroke,but no traditional risk factor was found in other 7 patients;2 patients showed single lesion in brain and 8 patients with two or more lesions due to the blockage of multiple cerebral arteries;7 patients showed an elevated plasma D-dimer level.Conclusion It is suggested that the acute ischemic stroke occurring in the patients with nasopharyngeal carcinoma commonly lacks traditional risk factors,with elevated plasma D-dimer levels and multiple lesions due to involvement of several cerebral arteries.