乳腺癌相关脑梗死的临床和影像学特征及危险因素分析

Clinical and Imaging Features and Risk Factors of Breast Cancer-related Cerebral Infarction

目的探讨乳腺癌相关脑梗死的临床特点和危险因素。方法本研究为回顾性病例对照分析,纳入2007年1月-2017年12月广西医科大学第一附属医院连续收治的30例乳腺癌相关脑梗死患者,按性别、年龄、肿瘤类型相匹配等原则分别选择30例单纯脑梗死和30例单纯乳腺癌患者作为对照。分析相比两对照组,乳腺癌相关脑梗死组的脑梗死临床及影像学特征、乳腺癌特征,应用多因素logistic回归分析乳腺癌患者发生脑梗死的危险因素。结果与单纯脑梗死组相比,乳腺癌相关脑梗死组多数患者的梗死灶为位于多支动脉供血区的多发小病灶,出院时死亡率增高(13.33%vs 0,P=0.048);与单纯乳腺癌组相比,乳腺癌相关脑梗死组多为晚期癌症(53.33%为Ⅲ、Ⅳ期),且发生远处转移者多见(70.00%vs 43.33%,P=0.037)。多因素logistic回归分析显示,血浆纤维蛋白原(OR 2.341,95%CI 1.013~5.411,P=0.047)和血清癌抗原153(OR 1.059,95%CI 1.006~1.115,P=0.027)水平升高,以及服用激素(OR 4.557,95%CI 1.009~20.579,P=0.049)是乳腺癌患者发生脑梗死的独立危险因素。结论乳腺癌相关脑梗死患者梗死灶特点多为累及多支动脉供血区的多发小病灶,多为晚期癌症,常发生远处转移,预后不良。而血浆纤维蛋白原、血清癌抗原153水平升高,以及服用激素是乳腺癌患者发生脑梗死的独立危险因素。

Objective To investigate the clinical and imaging characteristics and risk factors of breast cancerrelated cerebral infarction.Methods In this retrospective case-control study,30 patients with breast cancer-related cerebral infarction successively admitted to the First Affiliated Hospital of Guangxi Medical University between January 2007 and December 2017 were selected as the observation group,and 30 age-,gender-matched patients with only cerebral infarction and 30 age-,gender-,and tumor typematched patients with only breast cancer were selected as the controls.Compared to the two control groups,the clinical and imaging features of cerebral infarction,and the features of breast cancer in cerebral infarction patients with breast cancer were analyzed.Multivariate logistic regression analysis was used to determine the risk factors for cerebral infarction in breast cancer patients.Results Compared with only cerebral infarction group,infarcts of most patients in the observation group were multiple small lesions located in multi-artery territory,and the observation group had higher mortality at discharge(13.33%vs 0,P=0.048).The advanced cancer(stageⅢandⅣfor 53.33%)and distant metastasis(70.00%vs 43.33%,P=0.037)were more common in observation group than in only breast cancer group.Additionally,elevated levels of plasma fibrinogen(OR 2.341,95%CI 1.013-5.411,P=0.047)and serum cancer antigen(CA)153(OR 1.059,95%CI 1.006-1.115,P=0.027)and hormonotherapy(OR 4.557,95%CI 1.009-20.579,P=0.049)were independent risk factors for cerebral infarction in breast cancer.Conclusions The features of cerebral infarcts in breast cancer patients were multiple small infarcts involving multi-artery territory,the advanced cancer and distant metastases were more common in these patients,which tended to a poor prognosis.The elevated level of plasma fibrinogen and serum CA153,and the use of hormones may be independent risk factors for cerebral infarction in patients with breast cancer.