目的 比较恶性肿瘤患者与非肿瘤并发脑梗死患者的临床和影像特点。方法 回顾性分析2013年1月至2017年7月活动性恶性肿瘤发生急性脑梗死患者41例(研究组),选取同时期年龄、性别匹配的非肿瘤发生急性脑梗死患者41例为对照组。比较两组卒中危险因素、病因分型、临床表现、实验室指标(包括血红蛋白、高脂血症、血糖、凝血功能及D-二聚体)及脑梗死影像分布特点的差异,应用改良Rankin量表(mRS)评价脑梗死后30 d功能预后。结果 研究组高血压、高脂血症和既往卒中史所占比例低于对照组(χ2 > 5.549, P < 0.05),隐源性比例高于对照组(χ2 > 17.537, P < 0.05),血红蛋白水平显著低于对照组(t = 4.609, P < 0.001),D-二聚体水平显著高于对照组(t = -5.796, P < 0.001),病灶位于多支血管供血区比例(特别是病灶分布在双侧前循环+后循环)和多发小病灶比例均明显高于对照组(χ2 > 17.995, P < 0.01),病灶位于皮层/皮层下和小脑受累比例均明显高于对照组(χ2 > 8.159, P < 0.01),脑梗死后30 d mRS评分(t = -3.222, P < 0.01)和30 d死亡率(P < 0.05)高于对照组。结论 恶性肿瘤患者发生脑梗死相比于非肿瘤患者,隐源性机制更多见,D-二聚体升高更显著,病灶分布以多血管供血区的多发小病灶为特点,皮层/皮层下累及多见,幕下以小脑受累为主,临床表现易进展,预后差。临床如遇满足上述特点的脑梗死患者,应注意筛查肿瘤。
Objective To compare the differences of clinical and neuroimaging features between ischemic stroke patients with and without cancer. Methods From January 2013 and July 2017, 41 patients with active cancer diagnosed as acute ischemic stroke were retrospectively analyzed as research group. Besides, 41 age-and sex-matched patients diagnosed as acute ischemic stroke without cancer were selected as control group. The clinical date of both groups were collected and analyzed statistically. Results The percentages of hypertension, hyperlipidemia and past stroke were lower (χ2 > 5.549, P < 0.05), and the percentage of patients with cryptogenic stroke was higher in the research group than in the control group (χ2 > 17.537, P < 0.05). The hemoglobin level was lower (t = 4.609, P < 0.001), the D-dimer level was higher (t = -5.796, P < 0.001) in the research group than in the control group. Multiple vascular lesions of 53.7% patients in the research group were higher than 4.9% in the control group. The percentage of DWI lesions involving three vessel territories was higher in the research group than in the control group (χ2 > 17.995, P < 0.01). The percentage of multiple small lesions, and lesions located in cortical/subcortical lesions or cerebellum was higher in the research group than in the control group (χ2 > 8.159, P < 0.01). The 30 days mRS score after ischemic stroke (t = -3.222, P < 0.01) and the mortality rate within 30 days (P < 0.05) were higher in the research group than in the control group. Conclusion Compared with ischemic stroke patients without cancer, there were more cryptogenic stroke, higher D-dimer levels and poor prognosis in patients with active cancer. In ischemic stroke, patients with active cancer has a unique focal distributions characterized by more multiple vascular lesions involving three vessel territories and more lesions located in cortical/subcortical and cerebellum. The patients with ischemic stroke who conform to above characteristic should be paied attention to tumor screening.
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