胰腺癌相关脑梗死的临床特点及发病机制探讨

目的　初步探讨胰腺癌相关脑梗死的临床特点及可能的发病机制。方法　纳入2008年1月—2018年12月在广西医科大学第一附属医院及附属肿瘤医院治疗的胰腺癌相关脑梗死患者（胰腺癌尚未治愈，合并急性脑梗死且不伴有传统卒中因素）为胰腺癌相关脑梗死（PCCI）组，并按照1∶1比例收集同期年龄、性别匹配的单纯胰腺癌患者为（PC）组，对比分析2组患者临床资料。结果　PCCI组共纳入30例患者，其中性粒细胞绝对值、D-二聚体、CA125、CA199水平高于PC组（P＜0.05或P＜0.01）。PCCI组中24例（80.00%）表现为多个动脉供血区域的多发梗死灶，14例（46.67%）最大梗死灶直径≤2 cm，10例（33.33%）最大梗死灶直径为2~5 cm。20例（66.67%）在确诊胰腺癌后6个月内发生急性脑梗死。3例（10.00%）以急性脑梗死为首发表现，在住院期间确诊为胰腺癌。脑梗死TOAST分型以小动脉闭塞型及原因不明型为主。多因素Logistic回归分析显示血浆D-二聚体＞0.5 mg/L及CA199＞120 mg/L是PCCI的独立危险因素。结论　胰腺癌相关脑梗死发生机制可能与血液高凝状态、血管内微小血栓形成有关。

Clinical features and possible pathogenesis of pancreatic cancer-related cerebral infarction

Objective　To investigate the clinical features and possible pathogenesis of pancreatic cancer-related cerebral infarction (PCCI). Methods　Patients with pancreatic cancer-related cerebral infarction treated in the first affiliated hospital and the affiliated cancer hospital of Guangxi Medical University were included from January 2008 to December 2018. Patients with pancreatic cancer complicated with acute cerebral infarction while without traditional stroke factors were included in (PCCI) group. The age and sex matched patients with pancreatic cancer in the same period were chosen as pancreatic cancer (PC) group according to the ratio of 1∶1. The clinical data were analyzed between two groups. Results　A total of 30 patients were included in the PCCI group. The levels of plasma D-dimer, absolute value of neutrophils, CA125 and CA199 were significantly higher in PCCI group than those in PC group (P＜0.05 or P＜0.01). In the PCCI group, 24 (80.00%) patients presented with multiple lesions in multiple arterial territories. The diameters of the largest lesions were as follows:≤2 cm in 14 patients (46.67%) and 2-5 cm in 10 patients (33.33%). Twenty patients (66.67%) developed acute cerebral infarction within 6 months after the diagnosis of pancreatic cancer. Three patients (10.00%) had acute cerebral infarction as the initial manifestation and then were diagnosed as pancreatic cancer during hospitalization. The TOAST classification of cerebral infarction was mainly minor arterial occlusion and unknown cause. Multivariate Logistic regression analysis showed that the levels of plasma D-dimer＞0.5 mg/L and CA199＞120 mg/L were independent risk factors for PCCI. Conclusion　The mechanism of pancreatic cancer-related cerebral infarction may be related to the blood hypercoagulation and the formation of microthrombosis in blood vessels.