肺癌合并脑梗死的临床特点及其可能发病机制

发布时间：2019-06-19 07:31

【摘要】：目的探讨肺癌合并脑梗死患者的临床特点及其潜在的发病机制，提高临床上对本病的认识。 方法回顾性收集2003年1月至2012年12月在广西医科大学第一附属医院因肺癌接受治疗并在此治疗期间发生脑梗死的患者，或因脑梗死住院并在住院期间发现罹患肺癌的患者作为实验组（肺癌合并脑梗死组，Lungcancer and stroke group，LSG）。同时分别选择收录同期住院的相同例数且年龄、性别相匹配的单纯肺癌患者作为临床对照组1（单纯肺癌组，Lungcancer group， LG），以及相同例数且年龄、性别相匹配的单纯脑梗死患者作为临床对照组2（单纯脑梗死组，Stroke group，SG）。并对实验组患者传统脑血管病危险因素（Conventional risk for stroke, CRF）、脑梗死的症状体征及病因学分型、凝血功能指标、肿瘤标志物及头颅CT和/或磁共振成像（Magnetic resonance imaging, MRI）平扫或弥散加权成像（Diffusionweighted imaging, DWI）的表现以及肺癌病理类型、临床表现、治疗方法、预后等分别与对照组1、对照组2患者的资料进行比较。对LSG与LG患者比较中有意义的变量（按P 0.10的纳入标准）进行非条件Logistic回归分析，，以筛选肺癌患者发生脑梗死的危险因素。 结果共纳入符合条件的LSG患者102例，平均年龄（52.92±10.37）岁，其中男性84例（82.35%），女性18例（17.65%）；LG和SG也分别纳入102例患者，平均年龄与性别比例与LSG患者无明显差异。LSG患者中，23例（22.55%）以脑梗死为肺癌的首发表现，住院治疗脑梗死期间发现罹患肺癌，58例（56.86%）患者在确诊肺癌后前4个月内发生了脑梗死。与SG患者相比，LSG患者中无CRF、脑梗死病因分型为不明原因型脑梗死者、头颅CT或MRI或DWI显示脑梗死灶为累及多动脉供血区的多发性梗死灶者更多见，血液中D二聚体水平明显升高，发病30天时的预后更差，差异均有统计学意义（P 0.05）；与LG患者相比，LSG患者中发生转移者更多见，血液中D二聚体、肿瘤抗原（Cancer antigen, CA）125和CA199水平明显升高，差异均有统计学意义（P 0.05）。Logistic回归分析结果显示： CA125、CA199及D二聚体值升高是肺癌患者发生脑梗死的危险因素。D二聚体每升高1ug/mL，恶性肿瘤患者发生脑梗死的概率升高0.2%(OR,1.002;95%CI,1.000-1.004; P=0.017)；CA125每升高1U/ml，恶性肿瘤患者发生脑梗死的概率升高0.6%(OR,1.006;95%CI,1.001-1.010; P=0.017)；CA199每升高1U/ml，恶性肿瘤患者发生脑梗死的概率升高2.1%(OR,1.021;95%CI,1.011-1.024; P=0.000)。 结论在确诊肺癌后4个月内患者发生脑梗死的风险明显升高、多数患者缺少传统脑血管病危险因素、脑梗死原因不明、一次发病出现累及颅内多血管分布区的多发性病灶和预后差是肺癌患者发生脑梗死的临床特点；肺癌合并脑梗死的发生可能与癌细胞导致的血液高凝状态有关。
[Abstract]:Objective to investigate the clinical characteristics and potential pathogenesis of lung cancer complicated with cerebral infarction, and to improve the clinical understanding of the disease. Methods from January 2003 to December 2012, patients with cerebral infarction who received treatment for lung cancer and developed cerebral infarction during this treatment in the first affiliated Hospital of Guangxi Medical University, or patients hospitalized with cerebral infarction and found to have lung cancer during hospitalization, were collected as experimental group (lung cancer complicated with cerebral infarction group, Lungcancer and stroke group,LSG). At the same time, the patients with simple lung cancer with the same number of hospitalized patients and matched age and sex were selected as clinical control group 1 (simple lung cancer group, Lungcancer group, LG), and simple cerebral infarction patients with the same number and age and sex matching as clinical control group 2 (simple cerebral infarction group, Stroke group,SG). The symptoms, signs and etiological types, coagulation function indexes, tumor markers, plain scan or diffusion weighted imaging (Diffusionweighted imaging, DWI) of CT and / or magnetic resonance imaging (Magnetic resonance imaging, MRI), pathological type, clinical manifestation, treatment method and prognosis of lung cancer in the experimental group were compared with those in the control group. The data of control group 2 were compared. Non-conditional Logistic regression analysis was carried out to screen the risk factors of cerebral infarction in patients with lung cancer by non-conditional Logistic regression analysis of significant variables (according to the inclusion standard of P0.10) in patients with LSG and LG. Results A total of 102 patients with LSG were included, with an average age of (52.92 卤10.37) years, including 84 males (82.35%) and 18 females (17.65%). LG and SG were also included in 102patients, the average age and sex ratio were not significantly different from those in LSG patients. Among the patients with LSG, 23 (22.55%) had cerebral infarction as the first manifestation of lung cancer. Lung cancer was found in 58 patients (56.86%) during hospitalization, and cerebral infarction occurred in 58 patients (56.86%) within 4 months after diagnosis of lung cancer. Compared with SG patients, no CRF, cerebral infarction was diagnosed as unexplained cerebral infarction in LSG patients. CT or MRI or DWI showed that the cerebral infarction foci were multiple infarction foci involving multiple arterial blood supply areas, the level of D dimer in blood was significantly higher, and the prognosis was worse at 30 days after onset, the difference was statistically significant (P 0.05). Compared with LG patients, the levels of D dimer, tumor antigen (Cancer antigen, CA) 125 and CA199 in LSG patients were significantly higher than those in LSG patients (P 0.05). Logistic regression analysis showed that the increased CA125,CA199 and D dimer values were the risk factors for cerebral infarction in patients with lung cancer. The probability of cerebral infarction in patients with malignant tumor increased by 0.2% (OR,1.002;). 95% CI1.000 鈮

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