胃癌合并脑梗死的临床特点及危险因素分析

doi:10.3969/j.issn.1004-583X.2023.05.005

摘要/Abstract

摘要：

目的探讨胃癌合并脑梗死(gastric cancer-complicated stroke,GCS)患者临床特点和影响胃癌患者发生脑梗死的危险因素。方法纳入2014年1月至2019年12月在河北医科大学第四医院确诊并在诊治过程中新发脑梗死的胃癌患者(GCS组)42例,并选取同期就诊并在诊治过程中未出现过新发脑梗死的胃癌患者(对照组)84例。比较两组临床资料,分析GCS患者临床特点,并将两组差异有统计学意义的因素引入多因素Logistic回归分析,分析影响胃癌患者新发脑梗死的独立危险因素。结果本研究共收集42例GCS患者,其中男性34例,女性8例,年龄47~86岁,平均年龄(67.14±8.15)岁,所有胃癌患者病理类型均为腺癌。脑梗死发生在胃癌诊断后的0~985天,中位发病时间为38天,头颅磁共振成像(magnetic resonance imaging,MRI)提示颅内多个病灶、多部位受累22例(52.4%),因脑梗死后续未再进行胃癌的针对性治疗25例(59.5%)。GCS组高血压病史、糖尿病病史、高脂血症病史及既往脑梗死病史比例均高于对照组,差异有统计学意义(P<0.05)。GCS组凝血酶原时间、D-二聚体及糖类抗原199水高于对照组,而血红蛋白水平较对照组低,差异均有统计学意义(P<0.05)。GCS组手术史及化疗史比例低于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,既往脑梗死病史是GCS患者脑梗死的独立危险因素。结论脑梗死在胃癌诊断后的1~6个月内高发,传统脑卒中危险因素同样是胃癌患者发生脑卒中的危险因素,既往脑梗死病史是胃癌患者发生脑梗死的独立危险因素,这对预防及降低GCS的发生具有重要指导意义。

关键词: 胃肿瘤, 脑梗死, CA-199, 危险因素

Abstract:

Objective To investigate the clinical characteristics and risk factors of patients with gastric cancer-related stroke (GCS). Methods A total of 42 patients with gastric cancer who were diagnosed in the Fourth Hospital of Hebei Medical University from January 2014 to December 2019 and had new cerebral infarction in the course of diagnosis and treatment were included in GCS group. During the same period, eighty-four gastric cancer patients without new cerebral infarction occurred in the course of diagnosis and treatment were included in the control group. Clinical data and characteristics between groups were compared, and those with significant differences were introduced into the multivariate logistic regression analysis to analyze independent risk factors for new cerebral infarction in gastric cancer patients. Results A total of 42 GCS patients with the mean age of 67.14±8.15 (47-86) years were collected in this study, including 34 males and 8 female. They were pathologically diagnosed as gastric adenocarcinomas. Cerebral infarction occurred 0-985 days after the diagnosis of gastric cancer, with the median onset time of 38 days. Magnetic resonance imaging (MRI) showed that 22 cases (52.4%) had multiple lesions and multiple sites involved in the brain, and 25 cases (59.5%) did not receive targeted treatment for gastric cancer because of cerebral infarction. The proportion of hypertension history, diabetes history, hyperlipidemia history and previous cerebral infarction history in GCS group was significantly higher than that in the control group (P<0.05). The prothrombin time, D-dimer and carbohydrate antigen 199 levels in GCS group were significantly higher than those in the control group, while the hemoglobin level was significantly lower than that in the control group (P<0.05). The proportion of patients with surgical history and chemotherapy history in the GCS group was significantly lower than that in the control group (P<0.05). Multivariate logistic regression analysis showed that a previous history of cerebral infarction was an independent risk factor for cerebral infarction in GCS patients. Conclusion Cerebral infarction is highly prevalent within 1-6 months after the diagnosis of gastric cancer. Conventional risk factors for stroke are also independent risk factors for stroke in gastric cancer patients, so as the history of cerebral infarction. Our findings have a important guiding significance for preventing and reducing the occurrence of GCS.

Key words: stomach neoplasms, brain infarction, CA-199, risk factors

中图分类号:

R735.2

王英南, 赵琦, 白海威, 武丹娜, 魏金梅, 李省江, 李锐凌, 张瑞星. 胃癌合并脑梗死的临床特点及危险因素分析[J]. 临床荟萃, 2023, 38(5): 417-422.

Wang Yingnan, Zhao Qi, Bai Haiwei, Wu Danna, Wei Jinmei, Li Shengjiang, Li Ruiling, Zhang Ruixing. Clinical characteristics and risk factors of gastric cancer-related stroke[J]. Clinical Focus, 2023, 38(5): 417-422.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.05.005

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I5/417

图/表 5

参考文献 23

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3) :209-249. doi: 10.3322/caac.v71.3 URL
[2]	Qiu H, Cao S, Xu R. Cancer incidence, mortality, and burden in China: A time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020[J]. Cancer Commun (Lond), 2021, 41(10):1037-1048.
[3]	Motataianu A, Maier S, Gothard A, et al. Severe fatal systemic embolism due to non-bacterial thrombotic endocarditis as the initial manifestation of gastric adenocarcinoma: Case report[J]. Crit Care Med, 2018, 4(2):68-73.
[4]	Tsuji H, Hara S, Urano J, et al. Good controlled chylothorax in gastric carcinoma[J]. Gan To Kagaku Ryoho, 2018, 45(10):1449-1451.
[5]	Selvik HA, Bjerkreim AT, Thomassen L, et al. When to screen ischaemic stroke patients for cancer[J]. Cerebrovasc Dis, 2018, 45(1-2):42-47. doi: 10.1159/000484668 pmid: 29402826
[6]	Cestari DM, Weine DM, Panageas KS, et al. Stroke in patients with cancer: Incidence and etiology[J]. Neurology, 2004, 62(11):2025-2030. doi: 10.1212/01.wnl.0000129912.56486.2b pmid: 15184609
[7]	Navi BB, Howard G, Howard VJ, et al. The risk of arterial thromboembolic events after cancer diagnosis[J]. Res Pract Thromb Haemost, 2019, 3(4):639-651. doi: 10.1002/rth2.12223 pmid: 31624783
[8]	Aonuma AO, Nakamura M, Sakamaki K, et al. Incidence of cancer-associated thromboembolism in Japanese gastric and colorectal cancer patients receiving chemotherapy: A single-institutional retrospective cohort analysis (Sapporo CAT study)[J]. BMJ Open, 2019, 9(8) :e028563.
[9]	Tetzlaff ED, Cheng JD, Ajani JA, et al. Thromboembolism in gastrointestinal cancers[J]. Gastrointest Cancer Res, 2008, 2(6): 267-272.
[10]	Lin J, Wu S, Xu R, et al. Clinical characteristics and risk factors of lung cancer-associated acute ischemic stroke[J]. Biomed Res Int, 2019:6021037.
[11]	Saito E, Inoue M, Sawada N, et al. Risk of stroke in cancer survivors using a propensity score-matched cohort analysis. Sci Rep, 2021, 11(1) :5599. doi: 10.1038/s41598-021-83368-w pmid: 33692383
[12]	Majmudar K, Golemi I, Tafur AJ, et al. Outcomes after venous thromboembolism in patients with gastric cancer: Analysis of the RIETE Registry[J]. Vasc Med, 2020, 25(3):210-217. doi: 10.1177/1358863X19893432 pmid: 32000631
[13]	白海威, 祝琳, 刘畅, 等. 非神经系统恶性肿瘤患者围术期缺血性脑卒中的研究进展[J]. 实用心脑肺血管病杂志, 2020, 28(7):6-11.
[14]	Wei YC, Chen KF, Wu CL, et al. Stroke rate increases around the time of cancer diagnosis[J]. Front Neurol, 2019, 10:579. doi: 10.3389/fneur.2019.00579 URL
[15]	陶正平, 宋文灿, 程元骏. 非脑部恶性肿瘤患者发生脑梗死危险因素分析[J]. 创伤与急危重病医学, 2022, 10(3):228-231.
[16]	王权, 何慧薇. 老年贫血与其他疾病相关性回顾分析[J]. 实用老年医学, 2020, 34(4):4.
[17]	Long H, Qin K, Chen J, et al. Biomarkers of gastric cancer-related ischemic stroke and its underlying pathogenesis[J]. Medicine (Baltimore), 2018, 97(17):e0493. doi: 10.1097/MD.0000000000010493 URL
[18]	Di Castelnuovo A, Agnoli C, de Curtis A, et al. Elevated levels of D-dimers increase the risk of ischaemic and haemorrhagic stroke.Findings from the EPICOR study[J]. Thromb Haemost, 2014, 112(5):941-946. doi: 10.1160/th14-04-0297 URL
[19]	Shen Y, Li Y, Chen C, et al. D-dimer and diffusion-weighted imaging pattern as two diagnostic indicators for cancer-related stroke: A case-control study based on the STROBE guidelines[J]. Medicine (Baltimore), 2020, 99(4):e18779.
[20]	Ikushima S, Ono R, Fukuda K, et al. Trousseau's syndrome:Cancer-associated thrombosis[J]. Jpn J Clin Oncol, 2016, 46(3):204-208. doi: 10.1093/jjco/hyv165 URL
[21]	Bao L, Zhang S, Gong X, et al. Trousseau syndrome related cerebral infarction: Clinical manifestations, laboratory findings and radiological features[J]. J Stroke Cerebrovasc Dis. 2020, 29(9):104891.
[22]	国丽茹, 李彦青, 王澜涛, 等. 以多发急性脑梗死为首发表现的Trousseau综合征12例临床分析[J]. 中华全科医师杂志, 2019, 18(5):479-482.
[23]	Davies A, Van Leer L, Chan J, et al. Stroke in patients with cancer in the era of hyper-acute stroke intervention[J]. Intern Med J, 2022, 52(9):1513-1518. doi: 10.1111/imj.v52.9 URL

组别	例数		性别				年龄					高血压史				糖尿病史
组别	例数		男		女		≤60岁			>60岁		有		无		有		无
GCS组	42		34(81.0)		8(19.0)		9(21.4)			33(78.6)		21(50.0)		21(50.0)		12(28.6)		30(71.4)
对照组	84		68(81.0)		16(19.0)		24(28.6)			60(71.4)		23(27.4)		61(72.6)		6(7.1)		78(92.9)
χ²值			0.000				0.739					6.303				10.500
P值			1.000				0.390					0.012				0.001
组别		高脂血症史				冠心病史			吸烟史				饮酒史				既往脑梗死史
组别		有		无		有		无	有		无		有		无		有		无
GCS组		9(21.4)		33(78.6)		8(19.0)		34(81.0)	18(42.9)		24(57.1)		13(31.0)		29(69.0)		23(54.8)		19(45.2)
对照组		3(3.6)		81(96.4)		10(11.9)		74(88.1)	37(44.0)		47(56.0)		29(34.5)		55(65.5)		6(7.1)		78(92.9)
χ²值		8.393				1.167			0.016				0.161				35.834
P值		0.004				0.280			0.899				0.688				0.000

组别	例数		性别				年龄					高血压史				糖尿病史
组别	例数		男		女		≤60岁			>60岁		有		无		有		无
GCS组	42		34(81.0)		8(19.0)		9(21.4)			33(78.6)		21(50.0)		21(50.0)		12(28.6)		30(71.4)
对照组	84		68(81.0)		16(19.0)		24(28.6)			60(71.4)		23(27.4)		61(72.6)		6(7.1)		78(92.9)
χ²值			0.000				0.739					6.303				10.500
P值			1.000				0.390					0.012				0.001
组别		高脂血症史				冠心病史			吸烟史				饮酒史				既往脑梗死史
组别		有		无		有		无	有		无		有		无		有		无
GCS组		9(21.4)		33(78.6)		8(19.0)		34(81.0)	18(42.9)		24(57.1)		13(31.0)		29(69.0)		23(54.8)		19(45.2)
对照组		3(3.6)		81(96.4)		10(11.9)		74(88.1)	37(44.0)		47(56.0)		29(34.5)		55(65.5)		6(7.1)		78(92.9)
χ²值		8.393				1.167			0.016				0.161				35.834
P值		0.004				0.280			0.899				0.688				0.000

组别	例数	WBC计数 (×10⁹/L)	NEUT (×10⁹/L)	RBC计数 (×10¹²/L)	HGB (g/L)	PLT (×10⁹/L)	MPV (fL)	PT (s)	APTT (s)	FIB (g/L)	D-D (μg/ml)
GCS组	42	7.81±3.81	5.93±3.88	3.65±0.69	105.11±21.97	226.83±104.54	8.20±1.48	12.13±1.55	28.61±5.27	3.43±0.83	1.98±2.78
对照组	84	7.08±5.03	5.03±4.81	3.88±0.60	113.61±20.89	231.58±94.28	7.77±1.09	11.59±1.17	30.42±4.95	3.44±0.84	0.82±1.84
t值		0.829	1.051	-1.956	-2.116	-0.257	1.809	2.201	-1.894	-0.013	2.463
P值		0.409	0.295	0.053	0.036	0.798	0.073	0.030	0.061	0.990	0.017

组别	例数	WBC计数 (×10⁹/L)	NEUT (×10⁹/L)	RBC计数 (×10¹²/L)	HGB (g/L)	PLT (×10⁹/L)	MPV (fL)	PT (s)	APTT (s)	FIB (g/L)	D-D (μg/ml)
GCS组	42	7.81±3.81	5.93±3.88	3.65±0.69	105.11±21.97	226.83±104.54	8.20±1.48	12.13±1.55	28.61±5.27	3.43±0.83	1.98±2.78
对照组	84	7.08±5.03	5.03±4.81	3.88±0.60	113.61±20.89	231.58±94.28	7.77±1.09	11.59±1.17	30.42±4.95	3.44±0.84	0.82±1.84
t值		0.829	1.051	-1.956	-2.116	-0.257	1.809	2.201	-1.894	-0.013	2.463
P值		0.409	0.295	0.053	0.036	0.798	0.073	0.030	0.061	0.990	0.017

肿瘤标记物	组别	CEA(ng/ml)	AFP(ng/ml)	CA-199(U/ml)	CA-724(U/ml)
GCS组	42	39.31±68.25	7.93±20.95	185.03±317.85	81.43±229.18
对照组	84	84.28±240.41	11.33±54.93	83.82±197.54	12.75±36.72
t值		-1.591	-0.387	2.195	1.930
P值		0.115	0.699	0.030	0.060