本文關(guān)鍵詞： 急性缺血性腦卒中 急性多發(fā)性腦梗死 腫瘤 隱匿性惡性腫瘤 腫瘤相關(guān)性腦梗死 D-二聚體 高凝狀態(tài)　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:腫瘤患者的心腦血管事件風(fēng)險(xiǎn)增加,腫瘤患者腦梗死的梗死類型和發(fā)病機(jī)制與傳統(tǒng)腦血管病因引起腦梗死不同。腫瘤患者中,并非所有腫瘤患者腦卒中的發(fā)生都與腫瘤相關(guān)。腦梗死合并惡性腫瘤患者中常合并有D-二聚體值的升高。本研究進(jìn)一步分析了腫瘤相關(guān)性腦梗死的臨床及影像學(xué)特點(diǎn),及D-二聚體值與腫瘤相關(guān)的缺血性腦卒中的關(guān)系。方法:在我院數(shù)據(jù)庫中檢索2012年1月~2016年5月出院診斷關(guān)鍵字中包含有“腦梗死”和“腫瘤”或“癌癥”并調(diào)閱病例,最終納入了符合要求的61例急性缺血性腦梗死合并惡性腫瘤患者(腫瘤組),同時(shí)連續(xù)選取2015年2月10日~2015年3月20日在神經(jīng)內(nèi)科出院的未合并有腫瘤的單純急性腦梗死患者(對(duì)照組)76例作為對(duì)照。然后分析并總結(jié)兩組患者的臨床及影像學(xué)特點(diǎn)。本研究中,腦血管支配區(qū)域劃分為3個(gè)循環(huán),共23支血管;急性多發(fā)性腦梗死診斷標(biāo)準(zhǔn):在DWI上,非連續(xù)性的高信號(hào)分布在1個(gè)以上的大腦血管支配區(qū)域。腦梗死病灶按直徑劃分為大、中、小3種類型:小病灶為最大軸位直徑≤10 mm;中病灶為10 mm且≤30 mm;大病灶為30 mm。卒中復(fù)發(fā)指卒中癥狀達(dá)到高峰后原有癥狀再次突發(fā)加重或出現(xiàn)新的卒中癥狀。隨后,我們又對(duì)以急性腦梗死為首發(fā)表現(xiàn),之后查出惡性腫瘤患者的病史、化驗(yàn)及影像學(xué)特點(diǎn)進(jìn)行總結(jié)歸納。結(jié)果:與對(duì)照組相比,腫瘤組患者血液中D-二聚體值和纖維蛋白原降解產(chǎn)物的水平增高,纖維蛋白原水平下降。腫瘤組中,54.7%患者的D-二聚體值≤5.0μg/ml,其中占24.5%患者的D-二聚體值在正常參考值以內(nèi)。與對(duì)照組相比,腫瘤組患者具有傳統(tǒng)腦血管病危險(xiǎn)因素少,累及大腦血管個(gè)數(shù)多,腦梗死類型以多發(fā)性腦梗死和同時(shí)累及多個(gè)大腦循環(huán)的多發(fā)性腦梗死多見。以上臨床及影像學(xué)特征在D-二聚體5.0μg/ml的腫瘤患者中尤其明顯,而D-二聚體≤5.0μg/ml和對(duì)照組比較結(jié)果相似。以D-二聚體值等于5μg/ml為界區(qū)分腫瘤相關(guān)性腦梗死較以轉(zhuǎn)移/非轉(zhuǎn)移,活性/非活性具有較高的敏感性。而在以急性腦梗死為首發(fā)表現(xiàn),之后查出惡性腫瘤患者中,原發(fā)惡性腫瘤位于消化系統(tǒng)或肺部11例(84.6%),合并有腫瘤轉(zhuǎn)移11例(84.6%);行相關(guān)腫瘤指標(biāo)檢查的有12例,其中腫瘤指標(biāo)陽性8例(66.7%)。D-二聚體值增高11例(91.7%),FDP值增高10例(100%)。11例(84.6%)為多發(fā)性腦梗死,腦梗死病灶累及循環(huán)個(gè)數(shù)≥2的有10例(76.9%),前后循環(huán)同時(shí)累及8例(61.5%),小病灶占74.7%、中病灶占21.3%、大病灶占4.0%。結(jié)論:腫瘤相關(guān)性腦梗死患者具有:D-二聚體和纖維蛋白原降解產(chǎn)物值增高,纖維蛋白原水平下降,較少的傳統(tǒng)腦血管病危險(xiǎn)因素,腦梗死類型以累及多個(gè)大腦循環(huán)的多發(fā)性腦梗死多見。D-二聚體值以5μg/ml為界能夠更好的區(qū)分腫瘤相關(guān)性腦梗死。而在急性腦梗死為首發(fā)表現(xiàn)的隱匿性惡性腫瘤患者中,原發(fā)腫瘤多來源于消化系統(tǒng)或肺部,且腫瘤轉(zhuǎn)移比例高。D-二聚體和FDP值明顯增高,且陽性率高于腫瘤指標(biāo),梗死病灶容易出現(xiàn)在多個(gè)循環(huán)尤其是前后循環(huán)且以小病灶為主。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R730

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