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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。
Objective To analyze the diagnostic and therapeutic characteristics of polycythemia vera (PV), the first manifestation of stroke. Methods The clinical, CT and MRI findings, response to therapy and follow-up evaluation of 22 patients with PV who presented with stroke at first were evaluated. Results (1) The first manifestation of cerebrovascular disease, multiple cerebral infarction is the most common, accounting for 55.0% of total cerebrovascular disease secondary to PV. (2) Bleeding + chemotherapy group, the incidence of infarction progress rate of 37.5%, hemodilution + chemotherapy while hemodilution, steady improvement of infarction symptoms. (3) There were 3 electrocardiogram STT changes in 2 cases and 2 cases bone marrow suppression in 6 cases treated with homoharringtonine. Four cases of arsenic trioxide were treated, and the recurrence rate was 50.0% in two months. After treatment with hydroxyurea, it was relieved again. Hydroxyurea in 9 cases, all relieved. Conclusions (1) The routine treatment of cerebral infarction secondary to PV should be given at the same time for the treatment of PV. When blood is diluted, the blood is also exsanguinated. The response to hydroxyurea is relatively positive with relatively few side effects. (2) routine treatment of poor or short-term recurrent cerebral infarction patients should be routine examination of hematocrit.