CAJ | 학술논문

目的探讨肝癌合并脑梗死的临床特点及可能的发病机制.方法回顾性分析2005年1月至2012年12月,在住院接受肝癌治疗期间发生脑梗死以及住院接受急性脑梗死治疗期间证实患有肝癌患者的临床资料.结果共筛查原发性肝癌患者15 795例,其中符合肝癌合并脑梗死入选标准者32例(0.20％).入选患者中男26例(81.25％),女6例(18.75％),年龄27 ～68(45.63±11.01)岁.7例(21.87％)存在脑卒中危险因素,余25例(78.13％)无卒中危险因素.脑梗死发病急性期内,患者头颅MRI弥散成像(DWI)显示,脑内出现单一高信号病灶9例(28.12％),出现两个及以上不同动脉供血区高信号病灶23例(71.88％).肝细胞癌27例(84.38％),胆管上皮癌5例(15.62％),其中有14例(43.75％)已经发生转移.血液生化检查显示外周血甲胎蛋白水平升高29例,D二聚体水平升高23例,癌抗原(CA) 125水平升高21例、CA19-9水平升高17例.结论肝癌合并脑梗死患者大多数具有外周血D二聚体、甲胎蛋白及癌抗原水平升高、脑内出现多发性梗死灶等特点,其发生机制可能与患者血液凝固性升高有关.
목적 탐토간암합병뇌경사적림상특점급가능적발병궤제.방법 회고성분석2005년1월지2012년12월,재주원접수간암치료기간발생뇌경사이급주원접수급성뇌경사치료기간증실환유간암환자적림상자료.결과 공사사원발성간암환자15 795례,기중부합간암합병뇌경사입선표준자32례(0.20％).입선환자중남26례(81.25％),녀6례(18.75％),년령27 ～68(45.63±11.01)세.7례(21.87％)존재뇌졸중위험인소,여25례(78.13％)무졸중위험인소.뇌경사발병급성기내,환자두로MRI미산성상(DWI)현시,뇌내출현단일고신호병조9례(28.12％),출현량개급이상불동동맥공혈구고신호병조23례(71.88％).간세포암27례(84.38％),담관상피암5례(15.62％),기중유14례(43.75％)이경발생전이.혈액생화검사현시외주혈갑태단백수평승고29례,D이취체수평승고23례,암항원(CA) 125수평승고21례、CA19-9수평승고17례.결론 간암합병뇌경사환자대다수구유외주혈D이취체、갑태단백급암항원수평승고、뇌내출현다발성경사조등특점,기발생궤제가능여환자혈액응고성승고유관.
Objective To study the clinical features of liver cancer patients with acute ischemic stroke and to determine the pathogenesis of stroke.Methods The clinical data of in-hospital patients with liver cancer who developed acute ischemic stroke,including patients with liver cancer who developed acute ischemic stroke during anti-cancer therapies and those patients with acute ischemic stroke who were diagnosed to have liver cancer during anti-stroke therapies,from January 2005 to December 2012 were retrospectively reviewed.Results Of 15 795 patients with liver cancer,32 (0.20％) developed acute ischemic stroke.There were 26 men (81.25％) and 6 women (18.75％).Their age ranged from 27 to 68 years with a mean +/-S/D of 45.63 ± 11.01.Seven patients (21.87％) had some conventional cardiovascular risk factors,while the other 25 patients (78.13％) had no such risk factors.Magnetic resonance imaging (MRI) scans at the acute stage of ischemic stroke were carried out for all these patients.Based on the diffusion weighted imaging (DWI) of MRI,9 patients (28.12％) had one lesion and 23 patients (71.88％) had 2 or more lesions in different arterial territories in the brain.The subtypes of liver cancer were:liver cell cancer (27 patients,84.38％),and intrahepatic cholangiocarcinoma (5 patients,15.62％).In 14 patients (43.75％) metastases were found.29 patients had raised alpha fetal protein (AFP) levels,23 patients had high D dimer levels,21 patients had high cancer antigen (CA) 125 levels,and 17 patients had high CA19-9 levels.Conclusions Patients with liver cancer who developed acute ischemic stroke had distinct clinical features with high serum D dimmer,AFP and cancer antigen levels and multiple lesions in their brain.A hypercoagulability state of blood may partially be responsible for the pathogenesis of ischemic stroke in these patients.