肺癌相关急性缺血性脑卒中临床特征及危险因素分析

Clinical features and risk factors of lung cancer related acute ischemic stroke

目的探讨肺癌相关急性缺血性脑卒中的临床特征及危险因素,为临床诊治提供依据。方法对122例肺癌相关急性缺血性脑卒中患者的临床资料进行回顾性分析,依据出现肺癌或脑卒中首发就诊疾病的先后顺序将其分为脑卒中首发组(56例)和肺癌首发组(66例),分析其临床特征,并对肺癌相关急性缺血性脑卒中危险因素进行单因素分析及单因素回归分析、多元Logistic回归分析。结果肺癌相关急性缺血性脑卒中患者多为老年、男性,吸烟者占59.02%,病理类型以腺癌(59.60%)为主,发现时肿瘤常已多发转移(84.75%),患者多存在血液高凝状态(73.77%)及抑郁状态(61.62%),且同时累及多支脑动脉(64.29%)导致多发脑梗死(76.53%)。两组性别、双侧前后循环梗死、合并其他部位血栓、放化疗、纤维蛋白降解产物、D-二聚体、治疗后美国国立研究院卒中量表评分及改良Rankin量表评分方面比较差异有统计学意义(P<0.05或0.01)。多元Logistic回归分析结果显示,男性、吸烟、腺癌是肺癌相关急性缺血性脑卒中的独立危险因素(P<0.05或0.01)。结论临床发现同时累及多支脑动脉的急性多发性脑梗死应警惕肺癌相关急性缺血性脑卒中的可能,此类患者常存在血液高凝状态及抑郁状态。男性、吸烟、腺癌是其独立危险因素;以急性缺血性脑卒中为首发起病者30天预后较好,血液高凝状态相对较轻,易被漏诊和误诊。

Objective To explore the clinical features and risk factors of lung cancer related acute ischemic stroke(LC-AIS)in order to provide basis for clinical diagnosis and treatment.Methods Clinical data of 122 LC-AIS patients were retrospectively analyzed,they assigned to first-episode stroke(FES,n=56)and first-episode LC(FELC,n=66)group according to the sequence of first symptom of lung cancer or stroke,clinical features analyzed,and single factor analysis and multinomial logistics regression used to analyze the risk factors of the LC-AIS.Results LC-AIS patients were elderly and male mostly,smokers made up 59.02%,pathological pattern was mostly adenocarcinoma(59.60%),the tumor multiple metastases when discovered(84.75%),most of them had blood hypercoagulable state(73.77%)and depressive state(61.62%),and meanwhile the involvement of multiple cerebral arteries(64.29%)resulted in multiple cerebral infarction(76.53%).Intergroup differences in such indexes were statistically significant as sex,bilateral anterior and posterior circulation infarction,complicated thrombosis at other sites,chemoradiotherapy,fibrin degradation products,D-dimer,and post-treatment scores on the National Institute of Health Stroke Scale and Modified Rankin Scale(P<0.05 or 0.01).Multinomial logistics regression showed that male,smoking and adenocarcinoma were independent risk factors of the LC-AIS(P<0.05 or 0.01).Conclusion Patients with acute multiple cerebral infarction involved in multiple cerebral arteries at the same time should be alert to the possibility of LC-related stroke,such patients often have blood hypercoagulability and depression.Male,smoking and adenocarcinoma are independent risk factors of the LC-AIS;patients with AIS as first-episode manifestation have better prognosis after 30 days of onset and relatively milder hypercoagulable state and are easy to be missed and misdiagnosed.