癌症相关缺血性卒中临床特点及相关危险因素分析

Clinical Characteristics and Risk Factors of Cancer-Associated Ischemic Stroke

目的:探讨癌症相关缺血性卒中(cancer-associated ischemic stroke,CAIS)患者的临床特点及发病相关危险因素。方法:回顾性收集乐山市市中区人民医院神经内科2018年9月至2021年8月收治的1794例缺血性脑卒中(ischemic stroke,IS)患者的临床资料,根据IS患者发病前及住院期间是否被诊断为非神经系统活动性恶性肿瘤将其分为CAIS组(n=64)和非CAIS组(n=1730),比较2组患者入院时人口学特征、常见脑血管危险因素、实验室相关指标等指标,采用多因素Logistic回归模型探讨CAIS发生的独立危险因素。结果:64例CAIS患者中,既往患癌者45例(70.31%),在确诊恶性肿瘤后的1~35个月发生脑卒中,其余19例(29.69%)患者均为脑卒中住院期间偶然筛查发现的隐匿性癌症。多因素Logistic回归分析结果显示,30 d mRS评分(OR=2.059,P<0.001)、D-二聚体(OR=1.976,P=0.042)和纤维蛋白原(OR=1.567,P<0.001)是CAIS发生的独立危险因素。结论:30 d mRS评分、D-二聚体和纤维蛋白原的升高是CAIS发生的独立危险因素。

Objective:To investigate the clinical characteristics and risk factors of cancer-associated ischemic stroke(CAIS).Methods:Clinical data of 1,794 patients with ischemic stroke treated in the department of neurology in People’s Hospital of Central District of Leshan from September 2018 to August 2021 were collected retrospectively.Patients with or without non nervous system malignancy before onset or during hospitalization were assigned to the CAIS group(n=64)or the non-CAIS group(n=1,730).Demographic characteristics,cerebrovascular risk factors and laboratory findings in two groups were compared.Independent risk factors of CAIS were analyzed by using multivariate logistic regression model.Results:Among the 64 patients with CAIS,stroke occurred 1-35 months after cancer was confirmed in 45 cases(70.31%)with history of cancer,other 19 cases(29.69%)were occult cancer found by accidental screening during hospitalization.Multivariate logistic regression analysis showed that 30-day mRS score(OR=2.059,P<0.001),D-Dimer(OR=1.976,P=0.042)and fibrinogen(OR=1.567,P<0.001)were independent risk factors of CAIS.Conclusion:Increased 30 d mRS score,D-dimer and fibrinogen were independent risk factors of CAIS.