急性脑梗死合并恶性肿瘤患者的临床及影像学特点分析

发布时间：2018-02-24 08:27

本文关键词： 急性缺血性脑卒中急性多发性脑梗死肿瘤隐匿性恶性肿瘤肿瘤相关性脑梗死 D-二聚体高凝状态　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:肿瘤患者的心脑血管事件风险增加,肿瘤患者脑梗死的梗死类型和发病机制与传统脑血管病因引起脑梗死不同。肿瘤患者中,并非所有肿瘤患者脑卒中的发生都与肿瘤相关。脑梗死合并恶性肿瘤患者中常合并有D-二聚体值的升高。本研究进一步分析了肿瘤相关性脑梗死的临床及影像学特点,及D-二聚体值与肿瘤相关的缺血性脑卒中的关系。方法:在我院数据库中检索2012年1月~2016年5月出院诊断关键字中包含有“脑梗死”和“肿瘤”或“癌症”并调阅病例,最终纳入了符合要求的61例急性缺血性脑梗死合并恶性肿瘤患者(肿瘤组),同时连续选取2015年2月10日~2015年3月20日在神经内科出院的未合并有肿瘤的单纯急性脑梗死患者(对照组)76例作为对照。然后分析并总结两组患者的临床及影像学特点。本研究中,脑血管支配区域划分为3个循环,共23支血管;急性多发性脑梗死诊断标准:在DWI上,非连续性的高信号分布在1个以上的大脑血管支配区域。脑梗死病灶按直径划分为大、中、小3种类型:小病灶为最大轴位直径≤10 mm;中病灶为10 mm且≤30 mm;大病灶为30 mm。卒中复发指卒中症状达到高峰后原有症状再次突发加重或出现新的卒中症状。随后,我们又对以急性脑梗死为首发表现,之后查出恶性肿瘤患者的病史、化验及影像学特点进行总结归纳。结果:与对照组相比,肿瘤组患者血液中D-二聚体值和纤维蛋白原降解产物的水平增高,纤维蛋白原水平下降。肿瘤组中,54.7%患者的D-二聚体值≤5.0μg/ml,其中占24.5%患者的D-二聚体值在正常参考值以内。与对照组相比,肿瘤组患者具有传统脑血管病危险因素少,累及大脑血管个数多,脑梗死类型以多发性脑梗死和同时累及多个大脑循环的多发性脑梗死多见。以上临床及影像学特征在D-二聚体5.0μg/ml的肿瘤患者中尤其明显,而D-二聚体≤5.0μg/ml和对照组比较结果相似。以D-二聚体值等于5μg/ml为界区分肿瘤相关性脑梗死较以转移/非转移,活性/非活性具有较高的敏感性。而在以急性脑梗死为首发表现,之后查出恶性肿瘤患者中,原发恶性肿瘤位于消化系统或肺部11例(84.6%),合并有肿瘤转移11例(84.6%);行相关肿瘤指标检查的有12例,其中肿瘤指标阳性8例(66.7%)。D-二聚体值增高11例(91.7%),FDP值增高10例(100%)。11例(84.6%)为多发性脑梗死,脑梗死病灶累及循环个数≥2的有10例(76.9%),前后循环同时累及8例(61.5%),小病灶占74.7%、中病灶占21.3%、大病灶占4.0%。结论:肿瘤相关性脑梗死患者具有:D-二聚体和纤维蛋白原降解产物值增高,纤维蛋白原水平下降,较少的传统脑血管病危险因素,脑梗死类型以累及多个大脑循环的多发性脑梗死多见。D-二聚体值以5μg/ml为界能够更好的区分肿瘤相关性脑梗死。而在急性脑梗死为首发表现的隐匿性恶性肿瘤患者中,原发肿瘤多来源于消化系统或肺部,且肿瘤转移比例高。D-二聚体和FDP值明显增高,且阳性率高于肿瘤指标,梗死病灶容易出现在多个循环尤其是前后循环且以小病灶为主。
[Abstract]:Background: the risk of cardiovascular events in patients with tumor increased type of infarction and pathogenesis in patients with cerebral infarction and cerebral vascular tumor caused by traditional etiology. Cerebral infarction of different tumor patients, not all patients with cerebral tumor stroke are associated with cancer. Cerebral infarction complicated with malignant tumor patients often associated with elevated D- two dimer value. This study further analyzed the clinical and imaging features of tumor associated cerebral infarction, and the relationship between D- two dimer value of ischemic stroke associated with cancer. Methods: in our hospital in January 2012 May ~2016 database search keyword is included in the discharge diagnosis of cerebral infarction and "tumor" or "cancer" and access to the case. Included in the final to meet the requirements of the 61 cases of acute ischemic cerebral infarction patients with malignant tumor (tumor group), while continuously from February 10, 2015 ~2015 year in March 20th Department of neurology was not associated with tumor only in patients with acute cerebral infarction (control group) 76 cases as control. Then analyze and summarize the clinical and imaging characteristics of two groups of patients. In this study, cerebral vascular innervation area is divided into 3 cycles, a total of 23 vessels; acute multiple cerebral infarction diagnostic criteria: DWI, high signal distribution of non continuous blood vessels of the brain in 1 or more dominant area. Cerebral lesions according to diameter is divided into large, small, 3 types: small lesions for maximum axial diameter less than 10 mm; lesions in 10 mm and less than 30 mm; 30 mm. large lesions of recurrent stroke refers to stroke symptoms peaked after the original symptoms again sudden aggravation or new symptoms of stroke. Then, we went on to acute cerebral infarction as the first manifestation, then find out the patients with malignant tumor history, laboratory tests and imaging characteristics were summarized. Results: compared with the control group, Increased tumor patients blood two D- dimer and fibrinogen degradation product level, the level of fibrinogen decreased. Tumor group, 54.7% patients with two D- dimer value less than or equal to 5 mu g/ml, which accounted for 24.5% of patients two D- dimer value in normal reference value or less. Compared with the control group. The tumor patients with traditional risk factors of cerebral vascular disease, involving the number of blood vessels in the brain, cerebral infarction type with multiple cerebral infarction and multi infarct involving multiple brain circulation. See above clinical and radiological features especially in cancer patients D- two dimer of 5 g/ml, and two D- the dimer is less than or equal to 5 mu g/ml and the control group were similar to D-. Two dimer value is equal to 5 g/ml divided tumor associated cerebral infarction than to transfer / transfer, active / inactive with high sensitivity. In the acute cerebral infarction as the first manifestation, after check Patients with malignant tumor, primary malignant tumor in the digestive system or lung in 11 cases (84.6%), 11 cases with tumor metastasis (84.6%); related tumor markers examination in 12 cases, the tumor index was positive in 8 cases (66.7%) two.D- dimer value increased in 11 cases (91.7%), FDP in 10 cases (100%).11 (84.6%) cases of multiple cerebral infarction, cerebral infarction lesions involving the number of circulating more than 2 of the 10 cases (76.9%), before and after the cycle at the same time in 8 cases (61.5%), small lesions in lesions accounted for 74.7%, accounted for 21.3%, accounted for 4.0%. conclusion: large lesions correlated with the tumor of brain infarction patients: two D- dimer and fibrinogen degradation products increased fibrinogen level was decreased, the traditional cerebrovascular disease risk factors of cerebral infarction with type less, multi infarct involving multiple brain circulation. Two.D- dimer value to 5 g/ml is able to distinguish between tumor associated cerebral infarction better in acute. Occult malignant tumor in patients with cerebral infarction as the first manifestation of primary tumor originated from the digestive system or the lungs, and the proportion of tumor metastasis and high.D- two dimer and FDP values were significantly higher, and the positive rate is higher than that of tumor markers, infarction easily appear in more than one cycle before and after the circulation and especially for the small lesions.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R730

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