【摘要】 目的分析以脑卒中首发表现的真性红细胞增多症(PV)的诊断和治疗特点。方法22例以脑卒中首发表现的PV患者的临床、CT和MRI影像学表现、治疗反应和预后跟踪评价。结果(1)以脑血管病首发表现者,多发性脑梗死最常见,占PV继发脑血管病总数的55.0%。(2)放血+化疗组,梗死进展发生率37.5%,血液稀释的同时放血+化疗,梗死症状稳步改善。(3)高三尖杉酯碱治疗的6例中出现心电图STT改变3例,骨髓抑制2例。三氧化二砷治疗4例,2个月内复发率为50.0%,经羟基脲治疗后,再次缓解。羟基脲治疗9例,全部缓解。结论(1)PV继发的脑梗死常规治疗同时要针对PV治疗,血液稀释的同时放血,羟基脲疗效较肯定,不良反应相对较少。(2)常规治疗效果不佳或短期内反复发作的脑梗死患者应常规检查红细胞压积。更多还原

【Abstract】 Objective To analyze the particularities of diagnosis and treatment of acute cerebral stroke secondary to polycythemia vera (PV). Methods To track and evaluate the clinical parameters, the manifestations of CT/MRI, the data of laboratory examinations, the therapeutic responses and the prognosis of acute cerebral stroke secondary to PV. Twenty-two cases of PV with initial presentation as acute stroke were analyzed. Results (1)55.0% of the patients with stroke as the initial presentation of to PV had multiple lacuna infarction. (2) 37.5% of the patients had a temporary symptom aggravation after receiving a therapeutic regimen of blood-letting and chemotherapy, whereas, the stroke symptoms improved and became stable when treated with blood-letting combined with hemodilution and chemotherapy simultaneously.(3)Six cases received homoharringtonine treatment and all of them reached complete remission (CR). However, 3 of them showed ST segment and T-wave changes in electrocardiogram and 2 of them had bone marrow depression. Four cases received arsenic trioxide and obtained CR, but the relapse rate reached 50.0%. Nine cases were treated with hydroxycarbamide and all of them obtained CR. Conclusions (1) Stroke secondary to PV should be treated with stroke regimen as well as PV therapy, and hydroxycarbamide might have stable benefit and few side effects. (2)Hematocrit assay should be used as a routine item in stroke patients with frequently relapsed.更多还原