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    张琪, 李可可, 孟文晴, 杜楠, 屈小莹, 吉莹, 黄肖珊, 袁昕逸, 孔钰, 鲍磊, 陈浩, 金国良, 张沈阳. 活动性癌症合并脑梗死临床影像特征及其高危因素分析[J]. 徐州医科大学学报, 2022, 42(10): 703-709.
    引用本文: 张琪, 李可可, 孟文晴, 杜楠, 屈小莹, 吉莹, 黄肖珊, 袁昕逸, 孔钰, 鲍磊, 陈浩, 金国良, 张沈阳. 活动性癌症合并脑梗死临床影像特征及其高危因素分析[J]. 徐州医科大学学报, 2022, 42(10): 703-709.
    shu
    Clinical Imaging Features and High-Risk Factors of Active Active Cancer with Stroke[J]. Journal of Xuzhou Medical University, 2022, 42(10): 703-709.
    Citation: Clinical Imaging Features and High-Risk Factors of Active Active Cancer with Stroke[J]. Journal of Xuzhou Medical University, 2022, 42(10): 703-709.
    shu

    活动性癌症合并脑梗死临床影像特征及其高危因素分析

    Clinical Imaging Features and High-Risk Factors of Active Active Cancer with Stroke

      摘要
    • 摘要: 目的 通过对活动性癌症合并脑梗死患者临床影像特征及高危因素进行分析研究，进而提高临床医师对此疾病的认识。 方法 回顾性收集2012年1月至2020年12月在登记的活动性癌症合并脑梗死（Active cancer with stroke , ACS）的患者86例，选取与ACS组年龄、性别及癌症特点相匹配的未患有脑梗死的活动期癌症患者（Active cancer, AC）86例，对比分析两组的临床特征，探讨影响活动期癌症患者发生脑梗死的相关因素，再根据脑梗死的影像学特征将ACS组进一步分为单一血管分布区域组（single vascular territory , SV）及多个血管分布区域组(multiple vascular territories, MV)，进而分析活动期癌症发生脑梗死的影像学特征。 结果 ACS患者中，肺癌（39.5%）最多见，TMN分期为Ⅳ期的患者（52.3%）所占比例最高，腺癌（68.6%）是最常见的病理组织学类型。与AC组相比，ACS组白细胞、中性粒细胞、NLR、hs-CRP等炎症指标的水平较高（p均＜0.05），肿瘤指标CA125＞35u/ml的患者所占比例较高（p=0.003），DIC的发生率较高（p＜0.001）。在条件logistic回归分析中，血浆D-二聚体（≥5ug/ml）（OR 14.51；95%CI:3.45-60.98；P＜0.001）、Conut评分（每增加2分OR：2.22；95%CI:1.08-4.57；P=0.031）和血管危险因素（高血压、糖尿病、吸烟、饮酒、高脂血症）(≥2个)（OR：4.80；95%CI:1.74-13.21；P=0.002）与活动性癌症患者发生脑梗死独立相关。ACS组中的MV组的患者人数为51例（59.3%），其中有49%的患者出现同时累及3个循环区域（双侧前循环和后循环）的病灶，MV组与SV组相比较，在纤维蛋白原（median 2.99g/l vs 4.01g/l，p=0.000）、hs-CRP（median 37.50mg/l vs 11.90mg/l，p=0.000）、DIC(37.3%vs5.7%，p=0.001)及D-二聚体(≥5ug/ml)(72.3% vs 20.5%,p=0.000)等四个方面有统计学差异。 结论 活动性癌症合并脑梗死的患者往往表现为D-二聚体水平高、血管危险因素多、Conut评分高。高凝状态、血管危险因素以及营养不良或许是影响活动性癌症出现脑梗死的重要因素，对上述因素的改善也许可以减少癌症患者脑梗死的发生率。累及多个血管的多发性病灶是活动性癌症患者发生脑梗死的影像学特征，炎症效应及高凝状态可能与前者的形成有关。

       

      Abstract: ob＜x＞jective To improve clinicians’ understanding of the disease, we analyzed the clinical imaging characteristics and high-risk factors of patients with active cancer complicated with cerebral infarction. Methods 86 patients with active cancer related stroke (ACS) registered from January 2012 to December 2020 were retrospectively collected and a total of 86 active cancer (AC) patients without cerebral infarction were included as the control group. The clinical characteristics of the two groups were compared and analyzed, and the related factors affecting the occurrence of cerebral infarction in patients with active cancer were discussed. The ACS group was further divided into single vascular territory (SV) and multiple vascular territories (MV), and the imaging characteristics of cerebral infarction in active cancer were analyzed. Results Among ACS patients, lung cancer (39.5%) was the most common type, patients with TMN stage IV (52.3%) accounted for the highest proportion, and adenocarcinoma (68.6%) was the most common histopathological type. Compared with the AC group, the levels of inflammatory markers such as white blood cells, neutrophils, NLR, and hs-CRP in the ACS group were higher (all p < 0.05), the proportion of patients with tumor markers CA125 > 35u/ml was higher (p = 0.003), and the incidence of DIC was also higher (p < 0.001). Conditional logistic regression analysis showed plasma D-dimer (≥5ug/ml) (OR 14.51; 95%CI: 3.45-60.98; P<0.001), Conut score (OR: 2.22 for every 2 points increase; 95%CI): 1.08-4.57; P=0.031), together with vascular risk factors (≥2) (OR: 4.80; 95%CI: 1.74-13.21; P=0.002) were independently associated with cerebral infarction in patients with active cancer. In the ACS group, the number of patients in the MV group was 51 (59.3%), of which 49% had lesions involving three vascular territories (bilateral anterior circulation and posterior circulation) at the same time. Moreover, fibrinogen (median 2.99g/l vs 4.01g/l, p=0.000), hs-CRP (median 37.50mg/l vs 11.90mg/l, p=0.000), DIC (37.3%vs5.7%, p=0.001) and D-dimer (≥5ug/ml) (72.3% vs 20.5%, p=0.000) in the MV group were statistically different from that of the SV group. Conclusion Patients with active cancer-related stroke tend to have higher D-dimer levels, more vascular risk factors, and higher Conut scores. Hypercoagulable state, vascular risk factors, and malnutrition may be important factors affecting the onset of cerebral infarction in active cancer, and the improvement of these factors may reduce the incidence of cerebral infarction in cancer patients. Multiple lesions involving multiple-vascular territories are the classic imaging features of cerebral infarction in patients with active cancer, and inflammatory effects and hypercoagulability may contribute to the occurrence of active cancer-related stroke.

       

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