合并恶性肿瘤的脑梗死的临床特点及影响预后的相关因素分析

Clinical Features and Factors Influencing Prognosis of Ischemic Stroke in Cancer Patients

目的分析合并恶性肿瘤的脑梗死患者的临床特征及影像学特点,探讨影响患者预后的相关因素。方法回顾性分析2015年10月-2020年6月于中国医科大学附属第一医院神经内科收治的合并恶性肿瘤的脑梗死患者的临床资料,根据患者出院90 d时mRS评分将其分为预后良好组(mRS 0~2分)和预后不良组(mRS>2分)。采用多因素logistic回归模型分析影响合并恶性肿瘤的脑梗死患者预后的相关因素。结果共纳入51例患者,平均年龄65.2±9.3岁,男性38例(74.5%);预后良好组14例,预后不良组37例。多发性梗死33例(64.7%),双侧半球梗死31例(60.8%)。多因素分析结果显示,高血红蛋白水平为合并恶性肿瘤的脑梗死患者预后独立保护性因素(OR 0.925,95%CI 0.859~0.994),而高D-二聚体水平(OR 5.124,95%CI 1.289~20.373)及双侧半球梗死(OR 11.533,95%CI 1.151~115.542)为合并恶性肿瘤的脑梗死患者预后独立危险因素。结论合并恶性肿瘤的脑梗死患者影像学以多病灶、多血管支配区域受累为特点。高血红蛋白水平为合并恶性肿瘤的脑梗死患者预后保护性因素,而高D-二聚体水平及双侧半球梗死为预后危险因素。

Objective To analyze the clinical and imaging features of ischemic stroke in cancer patients,and the factors influencing the prognosis.Methods A retrospective analysis was performed for the data of ischemic stroke patients with cancer who admitted to Department of Neurology,the First Affiliated Hospital of China Medical University between October 2015 to June 2020.According to the mRS score at 90 days from discharge,they were divided into the groups of good prognosis(mRS≤2)or poor prognosis(mRS>2).Multivariate logistic regression analysis was used to analyze the factors influencing the prognosis.Results A total of 51 patients were included,with a mean age of 65.2±9.3 years and 38 males(74.5%).14 cases had good prognosis,and 37 cases had poor prognosis.33 cases(64.7%)developed cerebral multi-infarction,and 31 cases(60.8%)developed bihemispheric infarction.Multivariate analysis showed that higher hemoglobin level was an independent protective factor for the prognosis(OR 0.925,95%CI 0.859-0.994),while higher D-dimer level(OR 5.124,95%CI 1.289-20.373)and bihemispheric infarction(OR 11.533,95%CI 1.151-115.542)were independent risk factors for the prognosis.Conclusions The imaging features of cerebral infarction in cancer patients were multiple ischemic lesions and multiple-vascular-territory distribution.Higher hemoglobin level was a protective factor for prognosis of ischemic stroke in cancer patients,while higher D-dimer level and bihemispheric infarction were risk factors for prognosis.