2020 年第 2 期 第 15 卷

肺癌合并急性缺血性脑卒中发作患者的临床分析

Clinical characteristics of acute ischemic stroke in patients with lung cancer

作者：林佳才伍思婷徐睿崔芳石强邹雪刘辉

英文作者：

单位：中国人民解放军总医院海南医院神经内科，海南省三亚市572013

英文单位：

关键词：肺肿瘤；急性缺血性脑血管疾病；细胞角蛋白19片段抗原；D-二聚体；发病机制

英文关键词：

• 摘要：

• 【摘要】目的    探究肺癌合并急性缺血性脑卒中(AIS)发作的临床特点、实验室及影像学表现，并探讨AIS发作的病因。方法    回顾性分析2014年1月至2018年12月在中国人民解放军总医院海南医院确诊为肺癌且合并AIS发作的患者74例。收集患者基本信息、实验室检验结果、影像学报告、肿瘤组织病理等，进行统计分析。结果    本组74例患者中，42例（56.8%）为肺癌Ⅳ期；46例（62.2%）肺癌病理表现为腺癌，且以低分化多见。8例患者（10.8%）合并急性颅内出血病灶。5例患者（6.8%）住院期间死亡。按照急性脑卒中TOAST分型进行亚组分析，大动脉粥样硬化型18例（24.3%），心源性栓塞型2例（2.7%），小动脉闭塞型8例（10.8%），原因不明型46例（62.2%）；原因不明型组的细胞角蛋白19片段抗原（CYFRA211）、D-二聚体水平［14.9(5.8,41.4)μg/L、 1 736.5(434.0,4 240.5)μg/L］与其他组相比明显升高，差异均有统计学意义（均P＜0.05）。结合颅脑磁共振成像检查结果，发现D-二聚体水平与脑梗死病灶最大直径呈明显正相关（r＝0.323，P＝0.005）。结论    晚期肺腺癌患者需高度警惕性发作AIS的可能，其发作AIS的潜在原因可能与肺癌进展和血液高凝状态有关。

• 【Abstract】Objective    To analyze the clinical, laboratory and imaging characteristics of acute ischemic stroke(AIS) in patients with lung cancer, and to explore the etiology of AIS attack. Methods    Seventy-four patients with lung cancer and AIS attack were admitted to Hainan Hospital of Chinese PLA General Hospital from January 2014 to December 2018. Basic data, laboratory results, imaging findings and tumor histopathological reports were retrospectively analyzed. Results    Among the 74 patients, 42 patients（56.8%） suffered from stage Ⅳ lung cancer; 46 cases（62.2%） were lung adenocarcinoma and most tumors were poor differentiated. Eight patients（10.8%） had acute intracranial hemorrhage. Five patents（6.8%） died in hospital. According to the TOAST classification criteria of stroke, 18 cases（24.3%） were caused by large artery atherosclerosis; 2 cases（2.7%） were caused by cardiogenic embolism; 8 cases（10.8%） were caused by small artery embolism; 46 cases（62.2%） had unknown causes. Levels of cytokeratin-19 fragment antigen（CYFRA211） and D-dimer in stroke patients with unknown causes［14.9(5.8,41.4)μg/L, 1 736.5(434.0,4 240.5)μg/L］ were significantly higher than those in other patients（all P＜0.05）. D-dimer level was positively related with the maximum diameter of infarction foci measured by magnetic resonance imaging（r＝0.323，P＝0.005）. Conclusions    Patients with advanced lung adenocarcinoma have a high risk of AIS. The causes of AIS may be associated with the progression of lung cancer and blood hypercoagulability.