本文選題：前列腺癌 + 腦梗死��； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的探討前列腺癌相關腦梗死的發(fā)病特點。方法收集2003年1月~2015年12月在廣西醫(yī)科大學第一附屬院住院治療的前列腺癌合并腦梗死的患者臨床表現(xiàn)、實驗室及影像學檢查等臨床資料。結果本研究共篩查前列腺癌患者2584例,其中符合前列腺癌合并腦梗死的患者共有34例(1.31%),平均年齡為(61.60±6.28)歲。入選的患者中無腦卒中危險因素21例(61.76%)。血液學檢查發(fā)現(xiàn)D-二聚體水平升高22例(64.71%),總前列腺特異性抗原(Total prostate specific antigen,T-PSA)水平異常升高("g100ng/ml)19例(55.88%),頭顱MRI顯示腦內(nèi)單一梗死灶8例(23.52%),出現(xiàn)累及多個動脈供血區(qū)的2個或2個以上梗死灶26例(76.47%),腦梗死發(fā)生30d,多數(shù)患者預后不良,其中3例(8.82%)死亡。結論前列腺癌相關腦梗死的患者以缺少常見的腦血管病的危險因素、血漿D-二聚體水平升高以及T-PSA異常升高、一次發(fā)病出現(xiàn)累及多血管分布區(qū)的多發(fā)性梗死灶以及預后不良等為特點,其發(fā)生機制可能與患者血液的凝固性升高有關。目的探討前列腺癌相關腦梗死可能的發(fā)病機制,提高臨床對本病的認識。方法回顧性納入2003年1月至2016年12月于廣西醫(yī)科大學第一附屬醫(yī)院住院的前列腺癌相關腦梗死的患者23例作為前列腺癌相關腦梗死組(prostate cancer and stroke group,PSG),同時以1:4的比例隨機收錄同時期與觀察組性別、年齡相匹配的、缺乏傳統(tǒng)腦血管病危險因素的前列腺癌患者92例作為前列腺癌組(prostate cancer group,PG)。并對PSG組與PG組之間的血常規(guī)、凝血功能、D-二聚體、腫瘤標志物、顱腦及前列腺相關影像學資料、腦梗死患者的神經(jīng)功能缺損評分、預后評分、前列腺癌的危險度評分(Gleason評分)以及治療等進行比較。對PSG組、PG組間有一定意義的變量(P0.1)進行Logistic回歸分析,以進一步篩選前列腺癌相關腦梗死的獨立的危險因素。結果共納入符合標準的的前列腺癌相關腦梗死患者23例(PSG組),平均年齡(65.09±6.75)歲,同時納入缺乏傳統(tǒng)腦血管病危險因素的前列腺癌患者92例(PG組),平均年齡與PSG組無統(tǒng)計學差異。PSG組中所有患者均為不明原因型腦梗死,其中10例(43.5%)患者腦梗死發(fā)生在前列腺癌確診后6個月內(nèi);PSG組中16例(69.6%)患者出現(xiàn)顱內(nèi)累及多動脈供血區(qū)的多發(fā)梗死灶。與PG組相比,PSG組的前列腺癌轉移更多見,且前列腺癌Gleason評分更高,更多患者采用手術+術后內(nèi)分泌去勢治療,差異有統(tǒng)計學意義;血液學檢查發(fā)現(xiàn):PSG組的血漿D-二聚體水平、T-PSA較PG組顯著升高(p0.05),而Hb、CA125、CA199、CEA、AFP、PT、TT以及APTT兩組間無顯著差異。經(jīng)Logistic回歸分析示:D-二聚體、T-PSA是前列腺癌相關腦梗死的獨立的危險因素。結論本研究提示前列腺癌患者血漿D-二聚體、T-PSA水平異常升高是前列腺癌相關腦梗死較為明顯的血漿生物標志物且可能與其發(fā)生機制有關。
[Abstract]:Objective to investigate the characteristics of cerebral infarction associated with prostate cancer. Methods from January 2003 to December 2015, the clinical manifestations, laboratory and imaging data of patients with prostate cancer complicated with cerebral infarction who were hospitalized in the first affiliated Hospital of Guangxi Medical University were collected. Results A total of 2584 patients with prostate cancer were screened in this study. Among them, 34 patients with prostate cancer complicated with cerebral infarction had a mean age of 61.60 鹵6.28 years. No stroke risk factors were found in 21 of the selected patients. Hematological examination showed that the level of D-dimer was elevated in 22 cases (64.71%), and the total prostate specific antigen (TPA) was abnormally elevated ("g100ng/ml)19 case: 55.88%). Cranial MRI showed a single cerebral infarction in 8 cases (23. 52%), and 2 or 2 of the multiple arterial blood supply areas." 26 patients with more than 2 infarct foci had 30 days of cerebral infarction, and most of the patients had poor prognosis. Three of them died. Conclusion in patients with prostate cancer associated cerebral infarction, the levels of plasma D-dimer and T-PSA were increased in the absence of common risk factors of cerebrovascular disease. The occurrence of multiple infarcts with multiple vascular distribution and poor prognosis at one time may be related to the increase of blood coagulation. Objective to explore the possible pathogenesis of prostate cancer associated cerebral infarction and to improve the clinical understanding of the disease. Methods from January 2003 to December 2016, 23 patients with prostate cancer associated cerebral infarction who were admitted to the first affiliated Hospital of Guangxi Medical University as cancer and stroke group and PSG were retrospectively included, at 1:4. The sex of the same period and observation group were randomly collected, Age matched cancer group of 92 prostate cancer patients without traditional cerebrovascular risk factors were used as prostate cancer group. The blood routine, coagulation function of D-dimer, tumor markers, brain and prostate related imaging data, neurological deficit score and prognosis score of patients with cerebral infarction were also analyzed. The risk score for prostate cancer was compared with the Gleason score and treatment. Logistic regression analysis was carried out between PG group and PSG group in order to screen the independent risk factors of prostate cancer associated cerebral infarction. Results A total of 23 patients with prostate cancer associated cerebral infarction were included in the PSG group with an average age of 65.09 鹵6.75 years. At the same time, 92 patients with prostate cancer without traditional cerebrovascular risk factors were included in group PG, the mean age was not significantly different from that in PSG group. All patients in PSG group were classified as unexplained cerebral infarction. Ten patients with cerebral infarction occurred in PSG group within 6 months after the diagnosis of prostate cancer. Compared with PG group, prostate cancer metastasis was more common in PSG group, and the Gleason score of prostate cancer was higher than that in PG group, and more patients were treated with endocrine castration after operation, the difference was statistically significant. Hematologic examination showed that the plasma D-dimer level of T-PSA in the PSG group was significantly higher than that in the PG group, but there was no significant difference between the two groups. Logistic regression analysis showed that T-PSA was an independent risk factor for prostate cancer associated cerebral infarction. Conclusion this study suggests that the abnormal elevation of plasma D-dimer T-PSA level is a significant plasma biomarker in patients with prostate cancer associated cerebral infarction and may be related to its pathogenesis.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.25;R743.33

【參考文獻】

相關期刊論文 前1條

1 韓蘇軍;張思維;陳萬青;李長嶺;;中國前列腺癌發(fā)病現(xiàn)狀和流行趨勢分析[J];臨床腫瘤學雜志;2013年04期

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