前列腺癌相关脑梗死的发病特点及发病机制的临床研究

发布时间：2018-05-23 19:26

本文选题：前列腺癌 + 脑梗死　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的探讨前列腺癌相关脑梗死的发病特点。方法收集2003年1月~2015年12月在广西医科大学第一附属院住院治疗的前列腺癌合并脑梗死的患者临床表现、实验室及影像学检查等临床资料。结果本研究共筛查前列腺癌患者2584例,其中符合前列腺癌合并脑梗死的患者共有34例(1.31%),平均年龄为(61.60±6.28)岁。入选的患者中无脑卒中危险因素21例(61.76%)。血液学检查发现D-二聚体水平升高22例(64.71%),总前列腺特异性抗原(Total prostate specific antigen,T-PSA)水平异常升高("g100ng/ml)19例(55.88%),头颅MRI显示脑内单一梗死灶8例(23.52%),出现累及多个动脉供血区的2个或2个以上梗死灶26例(76.47%),脑梗死发生30d,多数患者预后不良,其中3例(8.82%)死亡。结论前列腺癌相关脑梗死的患者以缺少常见的脑血管病的危险因素、血浆D-二聚体水平升高以及T-PSA异常升高、一次发病出现累及多血管分布区的多发性梗死灶以及预后不良等为特点,其发生机制可能与患者血液的凝固性升高有关。目的探讨前列腺癌相关脑梗死可能的发病机制,提高临床对本病的认识。方法回顾性纳入2003年1月至2016年12月于广西医科大学第一附属医院住院的前列腺癌相关脑梗死的患者23例作为前列腺癌相关脑梗死组(prostate cancer and stroke group,PSG),同时以1:4的比例随机收录同时期与观察组性别、年龄相匹配的、缺乏传统脑血管病危险因素的前列腺癌患者92例作为前列腺癌组(prostate cancer group,PG)。并对PSG组与PG组之间的血常规、凝血功能、D-二聚体、肿瘤标志物、颅脑及前列腺相关影像学资料、脑梗死患者的神经功能缺损评分、预后评分、前列腺癌的危险度评分(Gleason评分)以及治疗等进行比较。对PSG组、PG组间有一定意义的变量(P0.1)进行Logistic回归分析,以进一步筛选前列腺癌相关脑梗死的独立的危险因素。结果共纳入符合标准的的前列腺癌相关脑梗死患者23例(PSG组),平均年龄(65.09±6.75)岁,同时纳入缺乏传统脑血管病危险因素的前列腺癌患者92例(PG组),平均年龄与PSG组无统计学差异。PSG组中所有患者均为不明原因型脑梗死,其中10例(43.5%)患者脑梗死发生在前列腺癌确诊后6个月内;PSG组中16例(69.6%)患者出现颅内累及多动脉供血区的多发梗死灶。与PG组相比,PSG组的前列腺癌转移更多见,且前列腺癌Gleason评分更高,更多患者采用手术+术后内分泌去势治疗,差异有统计学意义;血液学检查发现:PSG组的血浆D-二聚体水平、T-PSA较PG组显著升高(p0.05),而Hb、CA125、CA199、CEA、AFP、PT、TT以及APTT两组间无显著差异。经Logistic回归分析示:D-二聚体、T-PSA是前列腺癌相关脑梗死的独立的危险因素。结论本研究提示前列腺癌患者血浆D-二聚体、T-PSA水平异常升高是前列腺癌相关脑梗死较为明显的血浆生物标志物且可能与其发生机制有关。
[Abstract]:Objective to investigate the characteristics of cerebral infarction associated with prostate cancer. Methods from January 2003 to December 2015, the clinical manifestations, laboratory and imaging data of patients with prostate cancer complicated with cerebral infarction who were hospitalized in the first affiliated Hospital of Guangxi Medical University were collected. Results A total of 2584 patients with prostate cancer were screened in this study. Among them, 34 patients with prostate cancer complicated with cerebral infarction had a mean age of 61.60 卤6.28 years. No stroke risk factors were found in 21 of the selected patients. Hematological examination showed that the level of D-dimer was elevated in 22 cases (64.71%), and the total prostate specific antigen (TPA) was abnormally elevated ("g100ng/ml)19 case: 55.88%). Cranial MRI showed a single cerebral infarction in 8 cases (23. 52%), and 2 or 2 of the multiple arterial blood supply areas." 26 patients with more than 2 infarct foci had 30 days of cerebral infarction, and most of the patients had poor prognosis. Three of them died. Conclusion in patients with prostate cancer associated cerebral infarction, the levels of plasma D-dimer and T-PSA were increased in the absence of common risk factors of cerebrovascular disease. The occurrence of multiple infarcts with multiple vascular distribution and poor prognosis at one time may be related to the increase of blood coagulation. Objective to explore the possible pathogenesis of prostate cancer associated cerebral infarction and to improve the clinical understanding of the disease. Methods from January 2003 to December 2016, 23 patients with prostate cancer associated cerebral infarction who were admitted to the first affiliated Hospital of Guangxi Medical University as cancer and stroke group and PSG were retrospectively included, at 1:4. The sex of the same period and observation group were randomly collected, Age matched cancer group of 92 prostate cancer patients without traditional cerebrovascular risk factors were used as prostate cancer group. The blood routine, coagulation function of D-dimer, tumor markers, brain and prostate related imaging data, neurological deficit score and prognosis score of patients with cerebral infarction were also analyzed. The risk score for prostate cancer was compared with the Gleason score and treatment. Logistic regression analysis was carried out between PG group and PSG group in order to screen the independent risk factors of prostate cancer associated cerebral infarction. Results A total of 23 patients with prostate cancer associated cerebral infarction were included in the PSG group with an average age of 65.09 卤6.75 years. At the same time, 92 patients with prostate cancer without traditional cerebrovascular risk factors were included in group PG, the mean age was not significantly different from that in PSG group. All patients in PSG group were classified as unexplained cerebral infarction. Ten patients with cerebral infarction occurred in PSG group within 6 months after the diagnosis of prostate cancer. Compared with PG group, prostate cancer metastasis was more common in PSG group, and the Gleason score of prostate cancer was higher than that in PG group, and more patients were treated with endocrine castration after operation, the difference was statistically significant. Hematologic examination showed that the plasma D-dimer level of T-PSA in the PSG group was significantly higher than that in the PG group, but there was no significant difference between the two groups. Logistic regression analysis showed that T-PSA was an independent risk factor for prostate cancer associated cerebral infarction. Conclusion this study suggests that the abnormal elevation of plasma D-dimer T-PSA level is a significant plasma biomarker in patients with prostate cancer associated cerebral infarction and may be related to its pathogenesis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25;R743.33

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