肾癌相关脑梗死的临床特点及可能发病机制

The clinical features and possible pathogenesis of acute ischemic stroke in renal cell cancer patients

目的 探讨肾癌相关脑梗死的临床特点及其可能机制.方法 回顾性分析2003年1月至2015年12月住院接受肾癌治疗期间发生脑梗死以及住院接受急性脑梗死治疗期间证实患有肾癌患者的临床资料.结果 共筛查肾癌患者2516例,其中符合肾癌合并脑梗死入选标准者36例（1.43%）.入选患者中男29例（80.56%）,女7例（19.44%）,年龄45~80（65.11±14.77）岁.8例（22.22%）存在脑卒中危险因素,28例（77.78%）无脑卒中危险因素.脑梗死发病急性期内,患者头颅MRI弥散加权成像（DWI）显示,脑内出现单一高信号病灶8例（22.22%）,出现2个及以上不同动脉供血区高信号病灶28例（77.78%）.肾透明细胞癌18例（50.0%）,乳头状细胞癌12例（33.33%）,肾嫌色细胞癌6例（16.67%）,其中有10例（27.78%）已经发生转移.血液生化检查显示外周血D-二聚体水平升高28例,癌抗原（CA）125水平升高22例,癌胚抗原（CEA）水平升高17例.结论 肾癌相关脑梗死以患者缺少脑卒中危险因素、脑内出现多发性梗死灶为特点,其发生机制可能与患者外周血D-二聚体、CA125、CEA水平升高导致的血液高凝状态有关.

Objective To study the clinical features and possible pathogenesis of acute ischemic stroke in renal cell cancer patients. Methods The clinical data from in-hospital patients with renal cell cancer who developed acute ischemic stroke were collected, including the patients with renal cell cancer who developed acute ischemic stroke during anti-cancer therapies and those patients with acute ischemic stroke who were firstly diagnosed to have renal cell cancer during anti-stroke therapies between January 2003 and December 2015. Results A total of 2516 patients with renal cell cancer were screened, and there were 36 patients （1.43%） with acute ischemic stroke. Out of the 36 patients, there were 29 men （80.56%） and 7 women （19.44%）. Their age ranged from 45 to 68 years, with a average age of （65.11 ± 14.77） years. Eight patients （22.22%） had some conventional cardiovascular risk factors, while the other 28 patients （77.78%） had no such risk factors. Magnetic resonance imaging （MRI） scans at the acute stage of ischemic stroke were carried out for all these patients. Based on the diffusion weighted imaging （DWI） of MRI, 8 patients （22.22%） had single lesion and 28 patients （77.78%） had multiple lesions in different arterial territories in their brains. The pathological types of renal cell cancer were：suprarenal epithelioma （18 patients, 50.00%）, papillary cell carcinoma （12 patients, 33.33%） and chromophobe renal cell carcinoma （6 patients, 16.67%）. Metastases were found 10 patients （27.78%） out of the 36 patients. Blood biochemical examination showed that 28 patients had elevated plasma D-dimer level, 22 patients had elevated plasma cancer antigen （CA）125 level, and 17 patients had elevated plasma carcinoembryonic antigen （CEA） levels. Conclusions It is suggested that the renal cell cancer associated stroke is characterized by lacking of traditional risk factors and having multiple lesions in brain;and that the elevated plasma D-dimer, CA125 and CEA levels may lead to hypercoagulable state and lead to ischemic stroke eventually .