河北省南部实体肿瘤转移脑膜癌病单中心临床流行病学

Clinical epidemiological studies of meningitis carcinomatous from solid tumors in south Hebei

目的探讨实体肿瘤转移脑膜癌病的临床流行病学和临床特点。方法对本院2004年至2013年间收治的73例实体肿瘤转移脑膜癌病患者进行分析。结果其中肺癌来源28例（39.7%）、原发癌灶不明者27例（38.4%）、胃癌转移9例（12.3%）、乳腺癌3例（4%）、黑色素瘤2例（2.7%）,鼻咽癌、卵巢癌、脑胶质瘤、盆腔畸胎瘤各1例（1.4%）。2009年至2013年5年间发病较2004年至2008年增加2.65倍。男女比例1：1.15,中位发病年龄56±12岁,男女发病年龄差异无统计学意义（P〉0.05）,农民占80%,患者主要分布在河北省南部,石家庄地区居多。伴发病中2型糖尿病发病率8.22%,较社区人群高（P〈0.05）。入院后首次脑脊液细胞学（CSFC）检查发现肿瘤细胞者62例（88.57%）。接受鞘内化疗者17例（23.94%）,对部分患者随访发现不接受鞘内化疗15例患者生存期7.53w（m 5.5~9.57w）,鞘内化疗患者8例生存期25.00w（m14.14~35.86w）,鞘内化疗明显延长生存期。住院期间死亡率6.94%。结论河北省南部尤其是石家庄地区实体肿痛转移脑膜癌发病率增加趋势,鞘内化疗是有效地治疗脑膜癌的方法。

Objective To discuss the cilinical epidemiological and clinical characteristics of meningitis carcinomatous（ MC） from solid tumors.Methods 73 MC patients from solid tumors in the Second Hospital of Hebei Medical University from 2004 to 2013 were subjected to retrospective study. Results 28 cases were derived from lung cancer（ 39. 7%）,27 cases with unkown primary tumor（ 38. 4%）,9 cases from gastric cancer metastasis（ 12.3%）,3 cases from breast cancer（ 4%）,2 cases from melanoma（ 2. 7%）,1 case from nasopharyngeal carcinoma（ 1.4%）,and ovarian cancer,glioma,pelvic teratoma similarly. The hospitalization number of MC during2009-2013 was 2.65 times as much as that of the 2004-2008. Male / Female ratio was 1： 1.15. The distribution of onset age was 56±12,with no differences between male and female（ P 〉0.05）,80% patients were farmers. Most of them resided in south of Hebei province,especially in Shijiazhuang. The morbidity of type 2 diabetes was 8. 22%,which was higher than community groups（ P 〈0. 05）. After admission cerebrospinal fluid cytology（ CSFC） examination showed the tumor cells for the first time in 62 cases（ 88. 57%）. Intrathecal Methotrexate（ IT MTX） were administrated in 23.97% patients,we followed up 8 of them,whose survival time was 25.00 weeks（ m 14.14 weeks-35.86 weeks）. Meanwhile the survival time of 15 patients not received IT MTX treatment was 7. 53 weeks（ m 5. 5weeks-9.57 weeks）,so IT MTX treatment apparently prolonged the survival time of MC patients. The mortality of patient was 6.94% during hospitalized period. Conclusion The morbidity of MC is increasing in south of Hebei province,especially in Shijiazhuang,which should bring into attention. Early diagnose and treatment lead to the most benifits; IT MTX treatment is an effective method for the treatment of carcinomatous meningitis.