脑静脉窦血栓形成患者短期转归不良的预测因素研究

发布时间：2018-01-30 20:37

本文关键词： 脑静脉窦血栓形成预后危险因素 D-二聚体治疗　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis, CVST)患者短期转归不良的预测因素。方法：回顾性分析42例CVST患者的临床资料,根据出院时改良Rankin量表(modified Rankin Scale, mRS)评价临床转归,将病例组分为转归良好组(0-1分)和转归不良组(3-6分)。比较两组人口统计学、病因、临床特征等相关因素,采用多变量logistic回归分析确定CVST患者短期转归不良的独立预测因素,利用受试者工作特征曲线(receiver operating characteristic curve, ROC)分析确定其预测价值。结果：42例CVST患者mRS评分0分3例,1分10例,2分16例,3-5分11例,6分2例；31%的患者转归不良,病死率为4.8%。单因素分析显示,转归良好组与转归不良组之间的中枢神经系统感染、恶性肿瘤、妊娠、产褥期、口服避孕药或激素替代治疗、高同型半胱氨酸血症、治疗方式和基线D-二聚体水平存在显著性差异。多变量logistic回归分析显示,基线D-二聚体水平990ng/ml是CVST患者短期转归不良的独立预测因素(优势比1.006,95%可信区间1.002-1.011；P=0.005),抗凝联合溶栓治疗是CVST患者短期转归不良的独立保护因素(优势比0.027,95%可信区间0.002-0.447；P=0.033)。ROC曲线分析显示,基线D-二聚体截断值为990ng/ml时,其预测CVST短期转归不良的敏感性为76.9%,特异性为86.2%。结论：基线D-二聚体水平990ng/ml是CVST患者短者转归不良的独立预测因素；CVST患者实施抗凝联合溶栓治疗效果最佳。
[Abstract]:Objective: To investigate the cerebral venous sinus thrombosis (cerebral venous sinus thrombosis, CVST) the short-term prognostic factor in patients with poor outcome. Methods: retrospective analysis of the clinical data of 42 patients with CVST, according to the modified Rankin scale (modified Rankin Scale, mRS) to evaluate the clinical outcomes of the patients were divided into good outcome group (0-1) and poor outcome group (3-6). Comparison of two groups of demographics, etiology, clinical features and related factors, multivariate logistic regression analysis was used to identify independent predictors of CVST in patients with short-term outcome, using the receiver operating characteristic curve (receiver operating characteristic curve, ROC) analysis to determine its predictive value. Results: 42 cases of CVST patients with mRS score of 0 points in 3 cases, 1 cases were 10, 2 in 16 cases, 3-5 cases were 11, 6 in 2 cases; 31% patients with bad prognosis, the mortality rate was 4.8%. single factor analysis showed that a good outcome group With the infection of central nervous system adverse outcome between groups of malignant tumor, pregnancy, puerperium, oral contraceptives or hormone replacement therapy, hyperhomocysteinemia, treatment and baseline D- two dimer level there are significant differences. Multivariate logistic regression analysis showed that baseline D- two dimer level of 990ng/ml were independent prognostic factors the short-term outcome of patients with CVST (odds ratio 1.006,95% CI 1.002-1.011; P=0.005), anticoagulation combined thrombolytic therapy is an independent protective factor for CVST patients with poor prognosis (odds ratio 0.027,95% CI 0.002-0.447; P=0.033).ROC curve analysis showed that baseline D- two dimer cutoff value is 990ng/ml, the sensitivity of CVST to predict short-term outcome is 76.9%, the specificity was 86.2%. conclusion: D- two baseline level of D-dimer in patients with CVST 990ng/ml is short of independent factors predicting poor outcome in patients with CVST; The effect of anticoagulant combined with thrombolytic therapy is the best.

【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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