CAJ | 학술논문

目的提高对骨髓增殖性肿瘤伴发卒中诊断和治疗的认识. 方法收集2008年11月~2011年12月北京天坛医院血液科收治的骨髓增殖性肿瘤伴卒中患者的临床资料、实验室及影像学检查结果[包括病史、年龄、临床表现、颈部血管彩色多普勒超声、颅脑计算机断层扫描(computed tomography,CT)或磁共振成像(magnetic resonance imaging,MRI)、全血细胞计数、JAK2V617F基因突变检查],并对治疗随访评价. 结果骨髓增殖性肿瘤伴卒中16例,其中脑梗死13例,脑出血1例,短暂性脑缺血发作2例;脑梗死患者中4例患者梗死复发.真性红细胞增多症7例,原发性血小板增多症4例,原发性骨髓纤维化5例.7例患者卒中于骨髓增殖性肿瘤诊断前发生,8例同时诊断,1例骨髓增殖性肿瘤诊断后发生.13例有不同程度血细胞升高,13例行JAK2基因突变检测,阳性率76.9%.14例行颈部血管彩色多普勒超声检查均显示颈动脉和锁骨下动脉不同程度增厚、斑块形成伴狭窄.16例患者均服用阿司匹林治疗,其中15例患者同时接受羟基脲和(或)α干扰素治疗. 结论本组病例结果提示,卒中患者需仔细阅读全血细胞计数,重视骨髓增殖性肿瘤的诊断,JAK2基因突变检测有助于骨髓增殖性肿瘤的早期诊断.骨髓增殖性肿瘤患者常伴有颈部血管的结构异常.卒中患者需重视骨髓增殖性肿瘤的诊治.
목적제고대골수증식성종류반발졸중진단화치료적인식. 방법수집2008년11월~2011년12월북경천단의원혈액과수치적골수증식성종류반졸중환자적림상자료、실험실급영상학검사결과[포괄병사、년령、림상표현、경부혈관채색다보륵초성、로뇌계산궤단층소묘(computed tomography,CT)혹자공진성상(magnetic resonance imaging,MRI)、전혈세포계수、JAK2V617F기인돌변검사],병대치료수방평개. 결과골수증식성종류반졸중16례,기중뇌경사13례,뇌출혈1례,단잠성뇌결혈발작2례;뇌경사환자중4례환자경사복발.진성홍세포증다증7례,원발성혈소판증다증4례,원발성골수섬유화5례.7례환자졸중우골수증식성종류진단전발생,8례동시진단,1례골수증식성종류진단후발생.13례유불동정도혈세포승고,13례행JAK2기인돌변검측,양성솔76.9%.14례행경부혈관채색다보륵초성검사균현시경동맥화쇄골하동맥불동정도증후、반괴형성반협착.16례환자균복용아사필림치료,기중15례환자동시접수간기뇨화(혹)α간우소치료. 결론본조병례결과제시,졸중환자수자세열독전혈세포계수,중시골수증식성종류적진단,JAK2기인돌변검측유조우골수증식성종류적조기진단.골수증식성종류환자상반유경부혈관적결구이상.졸중환자수중시골수증식성종류적진치.
Objective To improve the understanding on the diagnosis and treatment of myeloproliferative neoplasms(MPNs) with stroke. @@@@Methods Patients suffering from MPNs with stroke at Department of Hematology of Beijing Tiantan Hospital from November 2008 to December 2011 were included in our study. Their clinical data, laboratory and radiological examination results(including medical history, age, clinical manifestation, color Doppler sonography, brain computed tomography[CT] or magnetic resonance imaging[MRI], complete blood count, and JAK2V617F mutation) were collected. Their treatment and follow-ups were also reviewed. @@@@Results There were 16 patients suffering from MPNs with stroke, among whom, 13 with cerebral infarct, 1 with cerebral hemorrhage and 2 with transient ischemic attack(TIA). Among those with cerebral infarct, 4 underwent relapse. There were 7 cases with polycythemia vera(PV), 4 with essential thrombocythemia(ET), and 5 with primary myelofibrosis(PMF). Seven patients developed stroke before the diagnosis of MPNs. Eight patients were diagnosed stroke and MPNs concurrently. One patient developed stroke after the diagnosis of MPNs. Thirteen patient had blood count increased in different extents. Thirteen patients underwent JAK2 gene mutation detection with a positive rate of 76.9%. Fourteen patients who had received carotid artery color Doppler ultrasound scanning were found the intimae-media thickness of their carotid and subclavian artery increased in different extents, and atherosclerotic plaque with stenosis. All 16 patients were treated with aspirin, and in the meantime 15 managed with hydroxyurea and/or interferon-α. @@@@Conclusion The medical records for patients suffering from MPN with stroke suggest that their complete blood count should be carefully reviewed, and more importance should be paid to the diagnosis of MPNs. JAK2V617F mutation detection is helpful to early diagnosis of MPNs. Patients with MPN often develop abnormal structure of neck blood vessel. The diagnosis and treatment of MPNs should be emphasized in stroke patients.