以急性脑梗死为表现的特鲁索综合征患者的临床及影像特征与预后分析

Clinical and imaging features and prognostic factors of acute ischemic stroke in patients with Trousseau's syndrome

目的 探讨表现为急性脑梗死的特鲁索综合征(Trousseau’s syndrome)的临床与影像特征以及预后因素。材料与方法 回顾性分析了65例表现为急性脑梗死的特鲁索综合征患者的临床资料及磁共振图像,依据改良Rankin量表(modified Rankin Scale, mRS)将患者分为预后良好组(mRS<3,n=35)或预后不良组(mRS≥3,n=30)。运用独立样本t检验、Mann-Whitney U检验及χ^(2)检验比较两组患者的特征差异。将单因素二元logistic回归分析后有统计学意义的指标纳入多因素二元logistic回归进行预后分析。另将患者分为无症状脑梗死组(n=25)与症状性脑梗死组(n=40),进行多因素二元logistic回归分析以探索患者出现症状性脑梗死的独立危险因素。结果 特鲁索综合征患者D-二聚体水平明显增高,梗死灶体积小、数量多、累及多血管供血区;相较于预后良好组,预后不良组的“三区域征”比例、梗死灶数目、NHISS评分、D-二聚体水平较高,红细胞、血红蛋白水平较低(P<0.05)。多因素logistic回归显示,D-二聚体水平是患者预后不良的独立危险因素(OR=5.094,95%CI:1.726~15.039);梗死体积是患者出现症状性脑梗死的独立危险因素(OR=1.227,95%CI:1.025~1.047)。结论 表现为急性脑梗死的特鲁索综合征患者的特征为高凝状态、累及多血管供血区的多发小梗死灶;D-二聚体水平是患者预后不良的独立危险因素;梗死体积是患者发生症状性脑梗死的独立危险因素。

Objective:To analyze clinical and imaging features of acute ischemic stroke(AIS)in patients with Trousseau's syndrome,and to explore the prognostic factors.Materials and Methods:A retrospective analysis was conducted on 65 patients with malignant tumor complicated with Trousseau's syndrome and their clinical and imaging features were summarized.Based on their modified Rankin Scale(mRS)score,patients were divided into good prognosis group(mRS<3,n=35)and poor prognosis group(mRS≥3,n=30).The features of the two groups were compared using independent sample t-test,Mann-Whitney U test orχ^(2) test.Indices with statistical significance in univariate binary logistic regression analysis were included in multivariate binary logistic regression analysis for prognostic analysis.Besides,patients were divided into asymptomatic cerebral infarction group(n=25)and symptomatic cerebral infarction group(n=40),and multivariate binary logistic regression analysis was performed to explore the independent risk factors of symptomatic cerebral infarction.Results:Patients with Trousseau's syndrome showed increased level of D-dimer,small and numerous infarcts in different vascular supply areas.Compared with the good prognosis group,the poor prognosis group showed higher proportion of three territory sign in MRI,greater number of cerebral infarctions,higher National Institutes of Health Stroke Scale(NIHSS)score at admission,higher level of D-dimer,lower level of hemoglobin(Hb)and red blood cell count(P<0.05).Multivariate analysis showed that increased D-dimer(OR=5.094,95%CI:1.726-15.039)was an independent prognostic factor for poor prognosis in such patients.Infarct volume was an independent risk factor for symptomatic cerebral infarction(OR=1.227,95%CI:1.025-1.047).Conclusions:Patients with AIS complicated with Trousseau's syndrome were characterized by hypercoagulation status and small and numerous infarcts in different vascular supply areas;increased D-dimer level is an independent prognostic risk factor and infarct volume was an independent risk factor for symptomatic cerebral infarction.