真性红细胞增多症并发脑卒中25例临床分析

目的：分析以脑卒中为首发表现的真性红细胞增多症（PV ）的诊断和治疗特点。方法我院1995年1月至2013年10月共收治PV并发脑卒中患者25例，临床表现有不同程度的头胀头晕无力健忘，以及皮肤黏膜红紫，同时伴有肢体麻木，皮肤瘙痒，脾肿大，高血压。脑卒中包括脑梗死、短暂性脑缺血发作、脑出血，表现为头晕、头痛、肢体运动障碍、面瘫、意识障碍等。血液检查血红蛋白及红细胞数慢性升高。骨髓检查显示各系造血细胞显著增生，红系明显，粒红比例下降。头颅CT或M RI检查提示丘脑梗死、基底节区脑梗死、脑叶梗死、脑干梗死、小脑梗死、脑出血。对于脑梗死给予抑制血小板聚集、低分子肝素、他汀类药物、改善脑循环、脑保护等治疗；对于PV的治疗：静脉放血，羟基脲治疗，干扰素治疗。结果25例患者经治疗，其中22例神经功能均获不同程度改善，达到临床缓解，2例病情加重，1例死亡。结论 PV并发脑卒中治疗困难，虽然有缓解的情况，但致残率高，预防非常重要。

The analysis of 25 cases of polycythemia vera complicating stroke

Objective To analysis to stroke the first manifestation of polycythemia vera (PV) in the diagnosis and treatment characteristics .Methods 1995 January 2013 October were treated 25 patients withpolycythemia vera in stroke patients ,clinical symptoms had different degrees of headache dizzy and weak forgetful ,and skin and mucous membrane red purple ,accompanied by numbness ,skin itching ,splenomegaly ,hypertension .Stroke include cerebral infarction ,transient ischemic attack ,cerebral hemorrhage ,manifested as dizziness ,headache ,limb movement disorder ,facial paralysis ,disturbance of consciousness .Exami‐nation of the blood hemoglobin and red blood cells of chronic elevation .Bone marrow examination showedmarked proliferation of various hematopoietic cells ,redlines was red ,the decline in the proportion of .Head CT orMRI showed that thalamic infarc‐tion ,cerebral infarction ,brain infarction in basal ganglia ,brainstem infarction ,cerebral infarction ,cerebral hemorrhage .For cer‐ebral infarction to inhibit platelet aggregation ,lowmolecular weight heparin ,statins ,improve cerebral circulation ,cerebral pro‐tection treatment ;for the treatment of polycythemia vera:venesection ,hydroxyurea ,interferon therapy .Results 25 patients after treatment ,22 cases of nerve function were improved in varying degrees ,to achieve clinical remission ,2 cases of illness , death in 1 cases .Conclusion polycythemia vera complicated withstroke treatment more difficult ,although there is relief ,but‐with high rate of disability ,prevention is very important .