【摘要】：目的探討肺癌合并腦梗死患者的臨床特點(diǎn)及其潛在的發(fā)病機(jī)制，提高臨床上對(duì)本病的認(rèn)識(shí)。 方法回顧性收集2003年1月至2012年12月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院因肺癌接受治療并在此治療期間發(fā)生腦梗死的患者，或因腦梗死住院并在住院期間發(fā)現(xiàn)罹患肺癌的患者作為實(shí)驗(yàn)組（肺癌合并腦梗死組，Lungcancer and stroke group，LSG）。同時(shí)分別選擇收錄同期住院的相同例數(shù)且年齡、性別相匹配的單純肺癌患者作為臨床對(duì)照組1（單純肺癌組，Lungcancer group， LG），以及相同例數(shù)且年齡、性別相匹配的單純腦梗死患者作為臨床對(duì)照組2（單純腦梗死組，Stroke group，SG）。并對(duì)實(shí)驗(yàn)組患者傳統(tǒng)腦血管病危險(xiǎn)因素（Conventional risk for stroke, CRF）、腦梗死的癥狀體征及病因?qū)W分型、凝血功能指標(biāo)、腫瘤標(biāo)志物及頭顱CT和/或磁共振成像（Magnetic resonance imaging, MRI）平掃或彌散加權(quán)成像（Diffusionweighted imaging, DWI）的表現(xiàn)以及肺癌病理類(lèi)型、臨床表現(xiàn)、治療方法、預(yù)后等分別與對(duì)照組1、對(duì)照組2患者的資料進(jìn)行比較。對(duì)LSG與LG患者比較中有意義的變量（按P 0.10的納入標(biāo)準(zhǔn)）進(jìn)行非條件Logistic回歸分析，，以篩選肺癌患者發(fā)生腦梗死的危險(xiǎn)因素。 結(jié)果共納入符合條件的LSG患者102例，平均年齡（52.92±10.37）歲，其中男性84例（82.35%），女性18例（17.65%）；LG和SG也分別納入102例患者，平均年齡與性別比例與LSG患者無(wú)明顯差異。LSG患者中，23例（22.55%）以腦梗死為肺癌的首發(fā)表現(xiàn)，住院治療腦梗死期間發(fā)現(xiàn)罹患肺癌，58例（56.86%）患者在確診肺癌后前4個(gè)月內(nèi)發(fā)生了腦梗死。與SG患者相比，LSG患者中無(wú)CRF、腦梗死病因分型為不明原因型腦梗死者、頭顱CT或MRI或DWI顯示腦梗死灶為累及多動(dòng)脈供血區(qū)的多發(fā)性梗死灶者更多見(jiàn)，血液中D二聚體水平明顯升高，發(fā)病30天時(shí)的預(yù)后更差，差異均有統(tǒng)計(jì)學(xué)意義（P 0.05）；與LG患者相比，LSG患者中發(fā)生轉(zhuǎn)移者更多見(jiàn)，血液中D二聚體、腫瘤抗原（Cancer antigen, CA）125和CA199水平明顯升高，差異均有統(tǒng)計(jì)學(xué)意義（P 0.05）。Logistic回歸分析結(jié)果顯示： CA125、CA199及D二聚體值升高是肺癌患者發(fā)生腦梗死的危險(xiǎn)因素。D二聚體每升高1ug/mL，惡性腫瘤患者發(fā)生腦梗死的概率升高0.2%(OR,1.002;95%CI,1.000-1.004; P=0.017)；CA125每升高1U/ml，惡性腫瘤患者發(fā)生腦梗死的概率升高0.6%(OR,1.006;95%CI,1.001-1.010; P=0.017)；CA199每升高1U/ml，惡性腫瘤患者發(fā)生腦梗死的概率升高2.1%(OR,1.021;95%CI,1.011-1.024; P=0.000)。 結(jié)論在確診肺癌后4個(gè)月內(nèi)患者發(fā)生腦梗死的風(fēng)險(xiǎn)明顯升高、多數(shù)患者缺少傳統(tǒng)腦血管病危險(xiǎn)因素、腦梗死原因不明、一次發(fā)病出現(xiàn)累及顱內(nèi)多血管分布區(qū)的多發(fā)性病灶和預(yù)后差是肺癌患者發(fā)生腦梗死的臨床特點(diǎn)；肺癌合并腦梗死的發(fā)生可能與癌細(xì)胞導(dǎo)致的血液高凝狀態(tài)有關(guān)。
[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 鹵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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