合并肺癌的急性缺血性卒中患者的转归及其影响因素

Outcomes and its influencing factors of ischemic stroke patients with lung cancer

目的探讨合并肺癌的缺血性卒中患者的转归及其影响因素。方法回顾性纳入2017年1月至2020年12月在天津市宁河区医院神经内科住院的合并肺癌的急性缺血性卒中患者。收集患者人口统计学及基线临床资料。主要转归指标为缺血性卒中发病后90 d时采用改良Rankin量表评价患者临床转归,0~2分定义为转归良好,3~6分定义为转归不良;次要转归指标为缺血性卒中发病后90 d内的出血事件,包括出血性转化和咯血。结果共纳入37例患者,男性25例(68%),女性12例(32%);年龄(72.6±8.0)岁;23例(62.2%)转归良好,14例(37.8%)转归不良。单变量分析显示,转归不良组基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分以及Ⅳ期肺癌、其他病因型脑梗死、中重度卒中、前循环+后循环脑梗死、双侧脑梗死、多发性脑梗死的患者构成比显著高于转归良好组,而轻度卒中、Ⅲ期肺癌、静脉溶栓的患者构成比显著低于转归良好组(P均<0.05)。多变量logistic回归分析显示,高基线NIHSS评分[优势比(odds ratio,OR)1.342,95%置信区间(confidence interval,CI)1.219~1.586;P=0.018]、Ⅳ期肺癌(OR 1.180,95%CI 1.088~2.187;P=0.042)、重度卒中(OR 1.216,95%CI 1.008~2.136;P=0.037)、多发性脑梗死(OR 1.508,95%CI1.005~1.516;P<0.001)与转归不良独立相关,而静脉溶栓治疗(OR 0.572,95%CI 0.262~0.802;P=0.001)与转归良好独立相关。此外,静脉溶栓患者的出血性转化和咯血发生率均显著高于非静脉溶栓患者(P均<0.05)。结论基线NIHSS评分较高、多发性脑梗死及晚期肺癌与肺癌合并缺血性卒中患者转归不良相关;静脉溶栓治疗与转归良好相关,尽管也会增高出血风险。

Objective To investigate the outcomes and its influencing factors of ischemic stroke patients with lung cancer.Methods Patients with acute ischemic stroke complicated with lung cancer admitted to the Department of Neurology,Ninghe District Hospital of Tianjin from January 2017 to December 2020 were retrospectively enrolled.The demographic and baseline clinical data were collected.The main outcome measure was the clinical outcome evaluated by the modified Rankin Scale at 90 days after the onset of ischemic stroke.0-2 was defined as a good outcome,and 3-6 was defined as a poor outcome.The secondary outcome measures were bleeding events within 90 d after the onset of ischemic stroke,including hemorrhagic transformation and hemoptysis.Results A total of 37 patients were enrolled,including 25 males(68%)and 12 females(32%);age 72.6±8.0 years;23 patients(62.2%)had a good outcome and 14(37.8%)had a poor outcome.The baseline National Institutes of Health Stroke Scale(NIHSS)score and the proportions of patients with stageⅣlung cancer,cerebral infarction due to other causes,moderate and severe stroke,anterior+posterior circulation cerebral infarction,bilateral cerebral infarction and multiple cerebral infarction in the poor outcome group were significantly higher than those in the good outcome group,while the proportion of patients with minor stroke,stageⅢlung cancer and intravenous thrombolysis were significantly lower than those of patients with good outcomes(all P<0.05).Multivariate logistic regression analysis showed that the high baseline NIHSS score(odd ratio[OR]1.342,95%confidence interval[CI]1.219-1.586;P=0.018),stageⅣlung cancer(OR 1.180,95%CI 1.088-2.187;P=0.042),severe stroke(OR 1.216,95%CI 1.008-2.136;P=0.037)and multiple cerebral infarction(OR 1.508,95%CI 1.005-1.516;P<0.001)were independently associated with the poor outcomes,while intravenous thrombolytic therapy(OR 0.572,95%CI 0.262-0.802;P=0.001)was independently associated with the good outcomes.In addition,the incidence of hemorrhagic transformation and hemoptysis in intravenous thrombolytic patients was significantly higher than that in the non-intravenous thrombolytic patients(all P<0.05).Conclusions Higher baseline NIHSS scores,multiple cerebral infarction and advanced lung cancer are associated with the poor outcomes in patients with lung cancer and ischemic stroke;intravenous thrombolytic therapy is associated with good outcomes,although it increased the risk of bleeding.