女性内生殖系统恶性肿瘤相关脑梗死的临床特点

摘要

目的探讨女性生殖系统恶性肿瘤合并脑梗死患者的临床特点及其可能的发病机制。方法分析2007年1月至2013年12月在广西医科大学第一附属医院因生殖系统恶性肿瘤住院接受治疗期间发生脑梗死的女性患者的临床资料。结果本组符合条件的患者9例，占同期1780例女性生殖系统恶性肿瘤的0．51％，年龄39～58岁，平均年龄51．56±7．20岁。肿瘤类型分别为子宫内膜癌4例、宫颈癌3例、卵巢癌2例，且所有患者肿瘤已经发生远处转移，其中血浆癌抗原125（CA-125）升高8例（88．89％），CA-199升高7例（77．78％）。脑梗死发生与肿瘤确诊后的9～42d，平均25．44±10．24d。9例患者中，6例（66．67％）患者无传统的脑卒中危险因素，6例（66．67％）外周血D-二聚体水平升高，6例（66．67％）脑内出现2个及以上分属于不同动脉供血区的病灶。脑梗死发病后90d 5例（55．56％）死亡。结论多数患者缺少传统的脑卒中危险因素，外周血D-二聚体、癌抗原水平升高，脑内出现涉及多条动脉供血区的多发性梗死灶，预后不良等可能是女性生殖系统肿瘤并发脑梗死的临床特点，并且血液高凝状态是其可能的发病机制之一。%Objective To investigate the clinical features of its potential pathogenesis of ischemic stroke the patients with female reproductive system malignant tumors .Methods The clinical data of of ischemic stroke patients with female reproductive system malignant tumor who were suffered from acute ischemic stroke and were admitted to the first affiliated hospital of Guangxi medical university from January 2007 to December 2013, were reviewed. Results Nine ischemic stroke patients with female reproductive system malignant tumor age from 39 to 58 year old and mean age (51.56 ±7.20) year old were enrolled, which accounted for 0.51%of the 1780 patients with female reproductive system malignant tumor at the same period .All of the reproductive system malignant tumor of the patient were metastasis and the subtypes of tumor involved endometrial adenocarcinoma (4cases),cervical adenocarcinoma (3 cases),and ovarian adenocarcinoma(2 cases).Of them,8 patients (88.89%)with elevated plasma CA125 level,7 patients(77.78%)with elevated plasma CA199.Ischemic stroke occurred from 9 days to 42days(and mean day 25.44 ±10.24) after malignant tumor determined .Six patients ( 66.67%) lack conventional vascular risks , with elevated plasma D-dimer level , and with two or more than two lesions in multiple artery supply regions in their brain .At 90 days after the cerebral infarction , 5 patients(55.56%) died.Conclusion It is suggested that the clinical feature of ischaemic stroke patients with female reproductive system malignant tumors include lack of conventional vascular risks, with a higher D-dimer level,CA125,CA199 levels, with two or more than two lesions in multiple arterial regions in their brain ,and poor prognosis .Coagulopathy may responsible for the pathogenesis .