脑静脉系统血栓形成的临床特点及影响预后的因素分析

发布时间：2018-05-18 20:39

  本文选题：脑静脉系统 + 血栓形成　； 参考：《广西医科大学》2014年硕士论文

【摘要】：目的：分析脑静脉系统血栓形成(CVT）的临床特点及影响预后的因素。 方法：连续入组2011年3月至2014年1月广西壮族自治区人民医院收住的CVT病例，经MRV、CTV或DSA确诊，接受标准抗凝治疗。记录并分析一般信息、危险因素、临床表现、血液和脑脊液检查结果、影像特征、3个月预后。以NIHSS量化神经功能障碍，GCS评估意识水平，mRS评估预后。应用X2检验或Fisher’s确切概率法对影响预后的因素行单因素分析，再把筛选出来p0.05的因素行Logistic回归多因素分析。 结果：（1）纳入CVT32例，男19例，男:女=1.46:1。年龄14-84岁，平均47.1岁，，＜60岁的青中年23例。（2）男性主要危险因素为高Hcy血症（47.4%）、吸烟（36.8%）；61.5%女性发病与妊娠相关。（3）亚急性起病65.6%，急性28.1%，慢性6.3%。高颅压症状最多见：头痛81.3%、恶心/呕吐31.3%，高颅压眼底改变31.3%；其次为局灶性神经功能受损：瘫痪40.6%、意识障碍37.5%、失语15.6%、小便失禁15.6%、感觉障碍12.5%、精神行为异常12.5%；癫痫发作：部分性15.6%，全面性6.3%。青中年组头痛发生率高于老年组（95.7%vs44.4%，p=0.003）。上矢状窦血栓的头痛发生率高于非上矢状窦血栓者（95.0%vs58.3%，p=0.018）；上矢状窦血栓的癫痫发生率高于非上矢状窦血栓者（35.0%vs0.0%，p=0.029）。直窦或Galen静脉血栓的意识障碍发生率高于非直窦或Galen静脉血栓者（75.0%vs25.0%，p=0.030）。青中年组平均NIHSS评分低于老年组（3.3±3.7vs10.9±7.9，p=0.020）。（4）影像学显示71.9%为多部位脑损伤。静脉性脑梗死46.9%、脑出血40.6%。血栓部位以上矢状窦（62.5%）、横窦（50.0%）、乙状窦（37.5%）多见；59.4%为多部位血栓。（5）出院后失访1例。3个月后mRS0-2分22例；mRS≥3-5分5例，死亡4例。单因素分析显示，年龄≥60岁、GCS9、NIHSS≥15、脑出血、直窦血栓、血栓部位≥3是预后不良的危险因素。多因素分析显示，年龄≥60岁（OR=8.62,95%CI：1.04-71.76,p=0.046）、GCS9（OR=8.35,95%CI:2.42-59.97, p=0.003）、脑出血（OR=5.01,95%CI:1.98-82.63, p=0.016）是3个月预后不良的独立危险因素。 结论：（1）CVT以青中年为主。高Hcy血症、吸烟为男性常见危险因素，女性发病主要与妊娠相关。（2）起病方式以亚急性多见。临床主要表现为高颅压症状、局灶性神经功能受损及癫痫，以头痛最常见。（3）多发性、跨动脉流域性脑梗死或出血是CVT的影像学特征。最多见的血栓部位是上矢状窦、横窦及乙状窦；血栓常累及多个部位。（4）CVT总体预后良好；年龄≥60岁、GCS9、NIHSS≥15、脑出血、直窦血栓、血栓部位≥3预示3个月预后不良；年龄≥60岁、GCS9、脑出血是3个月预后不良的独立危险因素。
[Abstract]:Objective: to analyze the clinical features and prognostic factors of cerebral venous thrombosis (CVT). Methods: CVT cases admitted to Guangxi Zhuang Autonomous region people's Hospital from March 2011 to January 2014 were confirmed by MRVV or DSA and received standard anticoagulant therapy. General information, risk factors, clinical manifestations, blood and cerebrospinal fluid findings, imaging features, 3 months prognosis were recorded and analyzed. NIHSS was used to evaluate the level of consciousness and the prognosis of patients with neurological dysfunction. Using X2 test or Fisher's exact probability method, the factors influencing prognosis were analyzed by univariate analysis, and the factors selected from p0.05 were analyzed by Logistic regression multivariate analysis. Results CVT32 included 19 males and 1.46: 1 females. Age 14-84 years (mean 47.1 years, < 60 years old: 23 cases, < 60 years old) the main risk factors of male were hyperHcy and 47.4%. 61.5% of women with smoking and 36.8% had acute onset of subacute disease (65.6%), acute 28.1%, chronic 6.33.The main risk factors were as follows: (1) the main risk factors were: 47.4% of the male patients with hyperthermia, 36.8% of the women with smoking and 36.8% of the women. The most common symptoms of high intracranial pressure were: headache 81.3, nausea / vomiting 31.33.3, cranial pressure changed 31.3; focal nerve function was damaged: paralysis 40.6, consciousness 37.5, aphasia 15.6. urinal incontinence 15.6cm, sensory disturbance 12.5., mental and behavioral abnormality 12.5.; epileptic hair. Work: partly 15.6b, 6.3cm in comprehensiveness. The incidence of headache in the middle-aged group was higher than that in the elderly group (95. 7 vs 44. 4). The incidence of headache in superior sagittal sinus thrombosis was higher than that in patients without superior sagittal sinus thrombosis, and the incidence of epilepsy in superior sagittal sinus thrombosis was higher than that in non-superior sagittal sinus thrombosis patients. The incidence of disturbance of consciousness in patients with venous thrombosis of straight sinus or Galen was higher than that of patients with venous thrombosis of non-straight sinus or Galen (75.0% vs 25.0% vs 0.030%). The average NIHSS score in the young and middle age group was lower than that in the elderly group (3.3 卤3.7vs10.9 卤7.9). The imaging findings showed that 71.9% of the patients had multi-site brain injury. Venous cerebral infarction was 46.9 and cerebral hemorrhage was 40.6. Above the thrombus site, 62.5% of the sagittal sinus, 50.0% of the transverse sinus and 37.5% of the sigmoid sinus were found to have multiple sites of thrombus. 1 case was lost after discharge. 3 months later, 22 cases of mRS0-2 score 鈮

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