CAJ | 학술논문

目的探讨恶性肿瘤患者脑梗死的临床特点及其可能的发病机制.方法连续收集2005年1月至2011年12月在广西医科大学第一附属医院接受躯体恶性肿瘤治疗,并在住院期间发生脑梗死的患者作为试验组(恶性肿瘤合并脑梗死组,STG)；同时分别选择性收录同期住院治疗的相同例数、年龄、性别相匹配的脑梗死患者作为单纯脑梗死组,以及相同例数、肿瘤类型、年龄、性别相匹配的恶性肿瘤患者作为单纯肿瘤组.结果共纳入符合条件的STG患者240例,同时分别选择性录入单纯脑梗死和单纯肿瘤组患者各240例.STG患者中肺癌是最常见的肿瘤类型85例(35.42％).与单纯脑梗死组比较,试验组患者脑梗死病因不明者多见,MRI表现以累及多个动脉供血区的多个病灶为特点.与单纯肿瘤组比较,试验组患者恶性肿瘤发生转移或复发者多见.Logistic回归分析结果显示:血小板计数每升高1×109/L,恶性肿瘤患者发生脑梗死的概率升高约1.3％(OR=1.013,95％CI1.005 ～1.022,P=0.002).部分激活的凝血酶原时间每降低1 s,肿瘤患者脑梗死风险增加15.4％(OR =0.846,95％CI0.771 ～0.929,P=0.000).采用过手术治疗的肿瘤患者发生脑梗死的危险性是未采用手术治疗的肿瘤患者的3.663倍(OR=3.663,95％CI1.584 ～ 8.473,P=0.002).结论恶性肿瘤合并脑梗死以缺少传统的危险因素、脑内出现多发性病灶为特点,恶性肿瘤患者血液凝固性升高是其可能的发生机制.
목적 탐토악성종류환자뇌경사적림상특점급기가능적발병궤제.방법 련속수집2005년1월지2011년12월재엄서의과대학제일부속의원접수구체악성종류치료,병재주원기간발생뇌경사적환자작위시험조(악성종류합병뇌경사조,STG)；동시분별선택성수록동기주원치료적상동례수、년령、성별상필배적뇌경사환자작위단순뇌경사조,이급상동례수、종류류형、년령、성별상필배적악성종류환자작위단순종류조.결과 공납입부합조건적STG환자240례,동시분별선택성록입단순뇌경사화단순종류조환자각240례.STG환자중폐암시최상견적종류류형85례(35.42％).여단순뇌경사조비교,시험조환자뇌경사병인불명자다견,MRI표현이루급다개동맥공혈구적다개병조위특점.여단순종류조비교,시험조환자악성종류발생전이혹복발자다견.Logistic회귀분석결과현시:혈소판계수매승고1×109/L,악성종류환자발생뇌경사적개솔승고약1.3％(OR=1.013,95％CI1.005 ～1.022,P=0.002).부분격활적응혈매원시간매강저1 s,종류환자뇌경사풍험증가15.4％(OR =0.846,95％CI0.771 ～0.929,P=0.000).채용과수술치료적종류환자발생뇌경사적위험성시미채용수술치료적종류환자적3.663배(OR=3.663,95％CI1.584 ～ 8.473,P=0.002).결론 악성종류합병뇌경사이결소전통적위험인소、뇌내출현다발성병조위특점,악성종류환자혈액응고성승고시기가능적발생궤제.
Objective To investigate the clinical features of cerebral infarction in patients with systemic malignant tumor as well as its underlying mechanism.Methods The patients who receiving the treatment of cancer experiencing a new infarct at the acute phase in the first affiliated hospital from January 2005 to December 2011 were consecutively collected as experimental group(stroke and tumor group,STG).At the same time,the patients without tumor experiencing a new infarct were consecutively collected as the stroke group matched with the experimental group on age,gender,and the patients who receiving the treatment of cancer without stroke were consecutively selected as the tumor group matched with the experimental group on age,gender and subtype of tumor.Results A total of 240 acute ischemic stroke patients with malignant tumor were enrolled.There were 22 kinds of tumor involved,in which lung cancer was the most common type,accounting for 35.42％ (85/240).Compared with the stroke group,the STG had a brain magnetic resonance imaging (MRI) features with multiple lesions in more than one artery territory,and had more patients with cryptogenic stroke.Compared with the tumor group,the STG had more patients with metastasis tumor.Multiple logistic regression analysis revealed that while platelet count increased by 1 × 109/L,the probability of cerebral infarction in patient with malignant tumor would increase by about 1.3％ (OR =1.013,95％ CI 1.005-1.022,P =0.002).The elongation of activated partial thromboplastin time played a protective role for stroke in patients with malignant tumor,and I s of its reducing caused the possibility of increasing cerebral infarction by 15.4％ (OR =0.846,95％ CI 0.771-0.929,P =0.000).The risk of cerebral infarction in tumor patients who had received surgical treatment was 3.663 times more than the cancer patients who did not receive it (OR =3.663,95％ CI 1.584-8.473,P =0.002).Conclusions Compared with the stroke patients without tumor,acute stroke patients in malignant tumor tend to have less cerebral vascular risk and multiple brain lesions.Coagulopathy may be its underlying mechanism.