关键词: 骨髓增殖性肿瘤; 卒中; 血栓形成; JAK2基因突变; 治疗

Abstract:

Objective To improve the understanding on the diagnosis and treatment of myeloproliferative neoplasms(MPNs) with stroke. Methods Patients suffering from MPNs with stroke at Department of Hematology of Beijing Tiantan Hospital from November 2008 to December 2011 were included in our study. Their clinical data, laboratory and radiological examination results(including medical history, age, clinical manifestation, color Doppler sonography, brain computed tomography[CT] or magnetic resonance imaging[MRI], complete blood count, and JAK2V617F mutation) were collected. Their treatment and follow-ups were also reviewed. Results There were 16 patients suffering from MPNs with stroke, among whom, 13 with cerebral infarct, 1 with cerebral hemorrhage and 2 with transient ischemic attack(TIA). Among those with cerebral infarct, 4 underwent relapse. There were 7 cases with polycythemia vera(PV), 4 with essential thrombocythemia(ET), and 5 with primary myelofibrosis(PMF). Seven patients developed stroke before the diagnosis of MPNs. Eight patients were diagnosed stroke and MPNs concurrently. One patient developed stroke after the diagnosis of MPNs. Thirteen patient had blood count increased in different extents. Thirteen patients underwent JAK2 gene mutation detection with a positive rate of 76.9%. Fourteen patients who had received carotid artery color Doppler ultrasound scanning were found the intimae-media thickness of their carotid and subclavian artery increased in different extents, and atherosclerotic plaque with stenosis. All 16 patients were treated with aspirin, and in the meantime 15 managed with hydroxyurea and/or interferon-α. Conclusion The medical records for patients suffering from MPN with stroke suggest that their complete blood count should be carefully reviewed, and more importance should be paid to the diagnosis of MPNs. JAK2V617F mutation detection is helpful to early diagnosis of MPNs. Patients with MPN often develop abnormal structure of neck blood vessel. The diagnosis and treatment of MPNs should be emphasized in stroke patients.

Key words: Myeloproliferative neoplasms; Stroke; Thrombosis; JAK2 mutation; Therapy