活动性癌症合并脑梗死患者临床影像特征及高危因素分析

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

doi:10.3969/j.issn.2096-3882.2022.10.001

活动性癌症合并脑梗死患者临床影像特征及高危因素分析

张琪¹,
李可可²,
孟文晴³,
杜楠⁴,
屈小莹⁴,
吉莹⁴,
黄肖珊⁴,
袁昕逸⁴,
孔钰⁴,
鲍磊⁵,
陈浩³,
金国良⁴,
张沈阳^5,6, ,

1. 盐城市第三人民医院神经内科, 江苏盐城 224000;
2. 徐州医科大学附属医院影像科, 江苏徐州 221002;
3. 徐州医科大学附属医院神经内科重症监护室;
4. 徐州医科大学研究生院, 江苏徐州 221004;
5. 徐州医科大学附属医院神经内科;
6. 东南大学医学院研究生院, 江苏南京 210000

基金项目:

国家自然科学资金(81971134)

徐州市科技局重点研发计划面上项目(KC19131)

详细信息

通讯作者:
张沈阳,E-mail:zhangshenyang111@163.com

中图分类号: R741
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出版历程
- 收稿日期: 2022-08-08
- 修回日期: 2022-10-07

Clinical imaging features and high-risk factors of active cancer related stroke

1. Department of Neurology, the Third People's Hospital of Yancheng, Yancheng, Jiangsu 224000, China;
2. Department of Medical Imaging, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002;
3. Neuroscience Intensive Care Unit, the Affiliated Hospital of Xuzhou Medical University;
4. Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221004;
5. Department of Neurology, the Affiliated Hospital of Xuzhou Medical University;
6. Graduate School, School of Medicine of Southeast University, Nanjing, Jiangsu 210000

摘要

摘要: 目的对活动性癌症合并脑梗死(ACS)患者的临床影像特征及高危因素进行分析。方法回顾性选取2012年1月—2020年12月在徐州医科大学附属医院就诊的ACS患者86例,并选取与ACS组年龄、性别及癌症特点相匹配的未患有脑梗死的活动性癌症患者86例(AC组)。对比分析2组的临床特征,探讨影响活动性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(SV)组及多个血管分布区域(MV)组,进而分析活动性癌症患者发生脑梗死的影像学特征。结果 ACS患者中,肺癌最多见,临床分期为Ⅳ期的患者所占比例最高,腺癌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、中性粒细胞淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)等炎症指标的水平较高(P均＜0.05),肿瘤指标CA125＞35 000 U/L的患者所占比例较高(P＜0.05),弥散性血管内凝血(DIC)的发生率较高(P＜0.05)。在条件Logistic回归分析中,血浆D-二聚体≥5 mg/L、营养控制状态(Conut)评分每增加2分和血管危险因素(高血压、糖尿病、吸烟、饮酒、高脂血症)≥2个与活动性癌症患者发生脑梗死独立相关(P＜0.05)。ACS组中MV组的患者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、hs-CRP、DIC及D-二聚体≥5 mg/L等方面的差异有统计学意义(P＜0.05)。结论高凝状态、血管危险因素以及营养不良或许是影响活动性癌症患者出现脑梗死的重要因素。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其形成有关。
- 活动性癌症 /
- 卒中 /
- 脑梗死 /
- 临床特征 /
- 影像学 /
- 高危因素
Abstract: Objective To analyzed the clinical imaging characteristics and high-risk factors of patients with active cancer related stroke (ACS). Methods A total of 86 patients who were diagnosed with ACS in the Affiliated Hospital of Xuzhou Medical University from January 2012 to December 2020 were enrolled as an ACS group. Meanwhile, another 86 active cancer patients without cerebral infarction were included as an AC group. Both groups were compared for clinical characteristics, and the related factors affecting the occurrence of cerebral infarction in patients with active cancer were discussed. The ACS group was further divided into two groups: a single vascular territory (SV) group and a multiple vascular territory (MV) group. Their imaging characteristics of cerebral infarction in active cancer patients were analyzed. Results Among ACS patients, lung cancer was the most common type. Patients with TNM stage IV accounted for the highest proportion, and adenocarcinoma was the most common histopathological type. Compared with the AC group, the ACS group showed increases in the levels of inflammatory markers such as white blood cells, neutrophils, neutrophil-lymphocyte ratio, and hs-CRP (all P<0.05), as well as an increased proportion of patients with tumor markers carbohydrate antigen (CA) 125>35 000 U/L (P<0.05), and an increased incidence of disseminated intravascular coagulation (DIC) (P<0.05). Conditional logistic regression analysis showed that plasma D-dimer (≥5 mg/L), controlling nutritional status (Conut) score, and more than two vascular risk factors (including hypertension, diabetes, smoking, alcohol drinking and hyperlipidemia) were independently associated with cerebral infarction in AS patients (P<0.05). In the ACS group, the number of patients in the MV group was 51 cases (59.3%), where 49% had lesions involving three vascular territories (the bilateral anterior circulation and posterior circulation). Moreover, there was statistical difference in fibrinogen, hs-CRP, DIC and D-dimer (≥5 mg/L) between the MV and SV groups (P<0.05). Conclusions Hypercoagulability, vascular risk factors, and malnutrition may be the important factors associated with ACS. Multiple lesions involving multiple-vascular territories are the imaging characteristics of active cancer patients, and inflammatory effects and hypercoagulability may contribute to the occurrence of ACS.
- active cancer /
- stroke /
- cerebral infarction /
- clinical features /
- imaging /
- high-risk factors

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参考文献(23)

[1]	Wang YJ,Li ZX,Gu HQ,et al.China stroke statistics 2019:a report from the national center for healthcare quality management in neurological diseases,China national clinical research center for neurological diseases,the Chinese stroke association,national center for chronic and non-communicable disease control and prevention,Chinese center for disease control and prevention and institute for global neuroscience and stroke collaborations[J].Stroke Vasc Neurol,2020,5(3):211-239.
[2]	Siegel RL,Miller KD,Jemal A.Cancer statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[3]	Navi BB,Reiner AS,Kamel H,et al.Association between incident cancer and subsequent stroke[J].Ann Neurol,2015,77(2):291-300.
[4]	Zaorsky NG,Zhang Y,Tchelebi LT,et al.Stroke among cancer patients[J/OL].Nat Commun,2019,10(1):5172.
[5]	Ling Y,Li Y,Zhang X,et al.Clinical features of Trousseau's syndrome with multiple acute ischemic strokes[J].Neurol Sci,2022,43(4):2405-2411.
[6]	Kwon HM,Kang BS,Yoon BW.Stroke as the first manifestation of concealed cancer[J].J Neurol Sci,2007,258(1/2):80-83.
[7]	Yoo J,Nam HS,Kim YD,et al.Short-term outcome of ischemic stroke patients with systemic malignancy[J].Stroke,2019,50(2):507-511.
[8]	Yuan Z,Cao DY,Yu M,et al.Importance of standard treatment in prognosis of patients with ovarian cancer and associated cerebral infarction[J].Clin Interv Aging,2020,15:151-157.
[9]	Wang MZ,Kou HM,Deng J,et al.Retrospective evaluation of new Chinese diagnostic scoring system for disseminated intravascular coagulation[J/OL].PLoS One,2015,10(6):e0129170.
[10]	Gon Y,Okazaki S,Terasaki Y,et al.Characteristics of cryptogenic stroke in cancer patients[J].Ann Clin Transl Neurol,2016,3(4):280-287.
[11]	Lee MJ,Chung JW,Ahn MJ,et al.Hypercoagulability and mortality of patients with stroke and active cancer:the OASIS-CANCER study[J].J Stroke,2017,19(1):77-87.
[12]	Bao L,Zhang SY,Gong XY,et al.Trousseau syndrome related cerebral infarction:clinical manifestations,laboratory findings and radiological features[J/OL].J Stroke Cerebrovasc Dis,2020,29(9):104891.
[13]	Schwarzbach CJ,Schaefer A,Ebert A,et al.Stroke and cancer:the importance of cancer-associated hypercoagulation as a possible stroke etiology[J].Stroke,2012,43(11):3029-3034.
[14]	Cestari DM,Weine DM,Panageas KS,et al.Stroke in patients with cancer:incidence and etiology[J].Neurology,2004,62(11):2025-2030.
[15]	Chen WQ,Zheng RS,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[16]	Chung JW,Cho YH,Ahn MJ,et al.Association of cancer cell type and extracellular vesicles with coagulopathy in patients with lung cancer and stroke[J].Stroke,2018,49(5):1282-1285.
[17]	McCrae KR.Novel mechanism of cancer thrombosis induced by microvesicles[J].Arterioscler Thromb Vasc Biol,2018,38(4):692-694.
[18]	Lee EJ,Nah HW,Kwon JY,et al.Ischemic stroke in patients with cancer:is it different from usual strokes? [J].Int J Stroke,2014,9(4):406-412.
[19]	Naito H,Nezu T,Hosomi N,et al.Antithrombotic therapy strategy for cancer-associated ischemic stroke:a case series of 26 patients[J/OL].J Stroke Cerebrovasc Dis,2018,27(9):e206-e211.
[20]	Kawano H,Honda Y,Amano T,et al.Subcutaneous heparin therapy for patients with cancer-associated stroke[J].J Stroke Cerebrovasc Dis,2019,28(2):399-404.
[21]	Navi BB,Iadecola C.Ischemic stroke in cancer patients:a review of an underappreciated pathology[J].Ann Neurol,2018,83(5):873-883.
[22]	Tsushima M,Metoki N,Hagii J,et al.D-dimer and C-reactive protein as potential biomarkers for diagnosis of trousseau's syndrome in patients with cerebral embolism[J/OL].J Stroke Cerebrovasc Dis,2020,29(2):104534.
[23]	Finelli PF,Nouh A.Three-territory DWI acute infarcts:diagnostic value in cancer-associated hypercoagulation stroke (trousseau syndrome)[J].Am J Neuroradiol,2016,37(11):2033-2036.