脑静脉系统血栓形成的早期诊断及临床特征分析
发布时间：2018-07-26 20:37
【摘要】：第一部分影响脑静脉系统血栓形成早期诊断的相关因素分析目的:由于CVT的症状、体征多变,在疾病的早期快速识别成为挑战。影响CVT诊断的因素多样,包括年龄、危险因素、临床症状、血D-D水平和影像学表现等,由于各个研究纳入病例严重程度不同以及诊治水平的不同,导致研究结果各不相同。本研究采用单因素及多因素分析方法进一步探讨影响脑静脉系统血栓形成(CVT)早期诊断的相关因素。方法:回顾性分析长海医院自2008年9月至2016年8月收治符合条件的104例CVT患者的临床资料,记录临床人口基线资料,现病史,既往史,实验室检查结果、影像学资料及治疗方法,出院前一天及随访时的mRS评分(Modified Rankin Scale,mRS)。根据发病到确诊时间分为早期诊断组(≤7天)和延迟诊断组(7天)。比较两组患者的基本临床资料,采用单因素和多因素Logistic回归分析影响疾病确诊的危险因素。结果:早期诊断组53例(51.0%),其中女性30例(56.6%),男性23例(43.4%);年龄18-64岁,平均年龄为34.13±13.78岁;延迟诊断组51例(49.0%),其中女性21例(41.2%),男性30例(58.8%);年龄18-75岁,平均年龄为42.57±15.07岁。单因素分析显示,年龄45岁(P=0.043)、孕产期发病(P=0.029)、血D-D(P=0.003)、脑实质损伤(P=0.000)、治疗后复查静脉再通(P=0.037)两组间比较差异有统计学意义。多因素Logistic回归分析显示,年龄(OR=4.197,95%CI=1.378~12.785;P=0.012)、血D-D(OR=0.896,95%CI=0.809~0.992;P=0.034)、脑实质损伤(OR=0.167,95%CI=0.052~0.540;P=0.003)是影响CVT早期诊断的独立危险因素。结论:年龄、血D-D水平、脑实质损伤是影响CVT早期诊断的重要因素。早期诊断可提高静脉再通率。第二部分侧窦血栓形成的临床特征分析目的:侧窦血栓形成(Lateral Sinus Thrombosis,LST)占脑静脉系统血栓形成(Cerebral venous thrombosis,CVT)的10%,因受对侧侧窦开放的代偿其临床症状缺乏典型性,成为误诊的重要原因。本研究将LST与其他部位血栓形成CVT患者的临床症状、影像学表现及治疗方式进行比较,探讨LST的临床特点及影像学规律,为临床诊断和治疗提供指导。方法:回顾性连续收集2008年9月至2016年8月于长海医院住院治疗确诊为CVT患者的住院病例资料,根据头颅MRV或CTV或DSA,将病例分为LST和其他部位血栓形成对比组,比较分析LST的临床特征。结果:104例CVT患者纳入研究,其中女性51例(49.0%),男性53例(51.0%);年龄18-75岁,平均38.20±14.44岁。影像学结果显示上矢状窦受累51例(49.0%),侧窦受累91例(87.5%),其中SSST7例(6.7%),LST33例(31.7%)。LST与其他部位血栓形成的临床特征比较分析:LST33(31.7%)例,年龄18-75岁,平均41.85±16.00岁;其他部位血栓形成71例(68.3%),年龄18-68岁,平均36.56±13.34岁。两组间年龄、性别及危险因素均无统计学差异(P0.05)。在临床症状方面,66.7%的LST患者仅表现为头痛,明显高于其他部位血栓形成的CVT患者(66.7%vs23.9%,P=0.001),但出现局灶性神经功能缺失症状及癫痫相对少见(P1=0.003、P2=0.000),其中出现偏瘫的患者比例同样低于其他部位血栓形成的CVT患者(3.0%vs22.5%,P=0.011);LST的颅内压增高比例及脑脊液压力平均值均低于其他部位血栓形成的CVT患者(P1=0.000、P2=0.000),而血D-D值及脑实质损伤两组间未见差异(P0.05);LST患者发病7天内确诊比例低于其他部位血栓形成(36.4%vs57.8%,P=0.042);在治疗的选择及近期神经功能预后两组间未见差异(P0.05)。LST与双侧侧窦受累的患者相比,LST颅内压增高的比例、脑脊液压力平均值较低(P1=0.013、P2=0.001),影像学检查脑实质损伤比例低(P=0.033)。结论:LST中有2/3的患者仅表现为头痛,出现局灶性神经功能缺失症状及癫痫相对少见。未受累静脉窦的开放代偿使得LST患者的颅内压升高程度相对较低。LST不易早期确诊。
[Abstract]:The first part of the analysis of the related factors affecting the early diagnosis of cerebral venous thrombosis: due to the symptoms of CVT, the changes in the signs and the early rapid identification of the disease become a challenge. The factors affecting the diagnosis of CVT are varied, including age, risk factors, clinical symptoms, blood D-D level and imaging manifestations, due to the severity of the study. Different levels of gravity and different levels of diagnosis and treatment resulted in different results. This study used single factor and multi factor analysis to further explore the related factors affecting the early diagnosis of cerebral venous thrombosis (CVT). Methods: a retrospective analysis of 104 cases of CVT patients who were eligible from September 2008 to August 2016 in Changhai Hospital were analyzed retrospectively. The clinical data, the clinical population baseline data, the current history, the past history, the laboratory examination results, the imaging data and the treatment methods, the mRS score (Modified Rankin Scale, mRS) at the day before discharge and the follow-up period were divided into the early diagnosis group (less than 7 days) and the delayed diagnosis group (7 days). Comparison of the two groups of patients was compared. Clinical data, single factor and multiple factor Logistic regression analysis were used to analyze the risk factors of disease diagnosis. Results: early diagnosis group was 53 cases (51%), of which 30 cases (56.6%), male 23 (43.4%), age 18-64, average age of 34.13 + 13.78, 51 cases (49%) in delayed diagnosis group, among which female 21 (41.2%), male 30 cases; age The average age of -75 years was 42.57 + 15.07 years. Univariate analysis showed that age 45 (P=0.043), pregnancy and birth (P=0.029), blood D-D (P=0.003), brain parenchyma damage (P=0.000), and two groups of reexamination of vein repassage (P=0.037) after treatment were statistically significant. Multiple factor Logistic regression analysis showed that age (OR=4.197,95%CI=1.378~12.785; P=0.0) 12), blood D-D (OR=0.896,95%CI=0.809~0.992; P=0.034), cerebral parenchymal injury (OR=0.167,95%CI=0.052~0.540; P=0.003) is an independent risk factor for the early diagnosis of CVT. Conclusion: age, blood D-D level, brain parenchyma injury are important factors affecting the early diagnosis of CVT. Early diagnosis can improve the rate of venous recanalization. The second part of the side sinus thrombosis is the main factor. Lateral Sinus Thrombosis (LST) accounts for 10% of the cerebral venous thrombosis (Cerebral venous thrombosis, CVT). The clinical symptoms are not typical due to the opening of the side side of the lateral sinuses. The clinical features and imaging rules of LST were compared, and the clinical features and imaging rules were explored to provide guidance for clinical diagnosis and treatment. Methods: a retrospective collection of hospitalized cases of CVT patients admitted to Changhai Hospital from September 2008 to August 2016 was collected, according to the head MRV or CTV or DSA, the cases were divided into LST and other cases. The clinical features of LST were compared and analyzed. Results: 104 cases of CVT were included in the study, including 51 women (49%), 53 men (51%), 18-75 years old, with an average of 38.20 + 14.44 years. The imaging results showed that the upper sagittal sinus was involved in 51 cases (49%), and the lateral sinus was involved in 91 (87.5%), including SSST7 (6.7%) and.LST with LST33 (31.7%).LST with LST33 Comparative analysis of clinical characteristics of thrombosis in his site: LST33 (31.7%) cases, age 18-75 years, average 41.85 + 16 years, 71 cases of thrombosis in other sites (68.3%), age 18-68 years, average 36.56 + 13.34 years old. Two groups of age, sex and risk factors are not statistically different (P0.05). In clinical symptoms, 66.7% of LST patients only manifested headache. CVT patients (66.7%vs23.9%, P=0.001) were significantly higher than other sites of thrombosis (66.7%vs23.9%, P=0.001), but the symptoms of focal neurological deficit and epilepsy were relatively rare (P1=0.003, P2=0.000), and the proportion of patients with hemiplegia was also lower than that of other CVT patients (3.0%vs22.5%, P=0.011); the proportion of increased intracranial pressure and cerebrospinal fluid in LST. The average pressure of pressure was lower than that of CVT (P1=0.000, P2=0.000) in other parts of thrombus, but there was no difference between the two groups of blood D-D and brain parenchyma (P0.05). The proportion of diagnosis in LST patients was lower than that of other sites (36.4%vs57.8%, P=0.042) in 7 days (36.4%vs57.8%, P=0.042), and there was no difference between the two groups in the choice of treatment and the prognosis of the recent neurological function (P0.05). .LST was compared with the patients with bilateral sinus involvement, the ratio of LST intracranial pressure increased, the mean cerebrospinal fluid pressure was lower (P1=0.013, P2=0.001), and the proportion of cerebral parenchyma damage was low (P=0.033). Conclusion: the patients with 2/3 in LST showed only headache, the symptoms of focal deletions and epilepsy were relatively rare. Open compensation makes intracranial pressure elevation of LST patients relatively low..LST is not easy to diagnose early.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2147224
[Abstract]:The first part of the analysis of the related factors affecting the early diagnosis of cerebral venous thrombosis: due to the symptoms of CVT, the changes in the signs and the early rapid identification of the disease become a challenge. The factors affecting the diagnosis of CVT are varied, including age, risk factors, clinical symptoms, blood D-D level and imaging manifestations, due to the severity of the study. Different levels of gravity and different levels of diagnosis and treatment resulted in different results. This study used single factor and multi factor analysis to further explore the related factors affecting the early diagnosis of cerebral venous thrombosis (CVT). Methods: a retrospective analysis of 104 cases of CVT patients who were eligible from September 2008 to August 2016 in Changhai Hospital were analyzed retrospectively. The clinical data, the clinical population baseline data, the current history, the past history, the laboratory examination results, the imaging data and the treatment methods, the mRS score (Modified Rankin Scale, mRS) at the day before discharge and the follow-up period were divided into the early diagnosis group (less than 7 days) and the delayed diagnosis group (7 days). Comparison of the two groups of patients was compared. Clinical data, single factor and multiple factor Logistic regression analysis were used to analyze the risk factors of disease diagnosis. Results: early diagnosis group was 53 cases (51%), of which 30 cases (56.6%), male 23 (43.4%), age 18-64, average age of 34.13 + 13.78, 51 cases (49%) in delayed diagnosis group, among which female 21 (41.2%), male 30 cases; age The average age of -75 years was 42.57 + 15.07 years. Univariate analysis showed that age 45 (P=0.043), pregnancy and birth (P=0.029), blood D-D (P=0.003), brain parenchyma damage (P=0.000), and two groups of reexamination of vein repassage (P=0.037) after treatment were statistically significant. Multiple factor Logistic regression analysis showed that age (OR=4.197,95%CI=1.378~12.785; P=0.0) 12), blood D-D (OR=0.896,95%CI=0.809~0.992; P=0.034), cerebral parenchymal injury (OR=0.167,95%CI=0.052~0.540; P=0.003) is an independent risk factor for the early diagnosis of CVT. Conclusion: age, blood D-D level, brain parenchyma injury are important factors affecting the early diagnosis of CVT. Early diagnosis can improve the rate of venous recanalization. The second part of the side sinus thrombosis is the main factor. Lateral Sinus Thrombosis (LST) accounts for 10% of the cerebral venous thrombosis (Cerebral venous thrombosis, CVT). The clinical symptoms are not typical due to the opening of the side side of the lateral sinuses. The clinical features and imaging rules of LST were compared, and the clinical features and imaging rules were explored to provide guidance for clinical diagnosis and treatment. Methods: a retrospective collection of hospitalized cases of CVT patients admitted to Changhai Hospital from September 2008 to August 2016 was collected, according to the head MRV or CTV or DSA, the cases were divided into LST and other cases. The clinical features of LST were compared and analyzed. Results: 104 cases of CVT were included in the study, including 51 women (49%), 53 men (51%), 18-75 years old, with an average of 38.20 + 14.44 years. The imaging results showed that the upper sagittal sinus was involved in 51 cases (49%), and the lateral sinus was involved in 91 (87.5%), including SSST7 (6.7%) and.LST with LST33 (31.7%).LST with LST33 Comparative analysis of clinical characteristics of thrombosis in his site: LST33 (31.7%) cases, age 18-75 years, average 41.85 + 16 years, 71 cases of thrombosis in other sites (68.3%), age 18-68 years, average 36.56 + 13.34 years old. Two groups of age, sex and risk factors are not statistically different (P0.05). In clinical symptoms, 66.7% of LST patients only manifested headache. CVT patients (66.7%vs23.9%, P=0.001) were significantly higher than other sites of thrombosis (66.7%vs23.9%, P=0.001), but the symptoms of focal neurological deficit and epilepsy were relatively rare (P1=0.003, P2=0.000), and the proportion of patients with hemiplegia was also lower than that of other CVT patients (3.0%vs22.5%, P=0.011); the proportion of increased intracranial pressure and cerebrospinal fluid in LST. The average pressure of pressure was lower than that of CVT (P1=0.000, P2=0.000) in other parts of thrombus, but there was no difference between the two groups of blood D-D and brain parenchyma (P0.05). The proportion of diagnosis in LST patients was lower than that of other sites (36.4%vs57.8%, P=0.042) in 7 days (36.4%vs57.8%, P=0.042), and there was no difference between the two groups in the choice of treatment and the prognosis of the recent neurological function (P0.05). .LST was compared with the patients with bilateral sinus involvement, the ratio of LST intracranial pressure increased, the mean cerebrospinal fluid pressure was lower (P1=0.013, P2=0.001), and the proportion of cerebral parenchyma damage was low (P=0.033). Conclusion: the patients with 2/3 in LST showed only headache, the symptoms of focal deletions and epilepsy were relatively rare. Open compensation makes intracranial pressure elevation of LST patients relatively low..LST is not easy to diagnose early.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
【参考文献】
相关期刊论文 前10条
1 李宝民;梁永平;曹向宇;王君;刘新峰;杨春水;王传明;;脑静脉窦狭窄的影像解剖特征与临床诊治的探讨[J];中华医学杂志;2015年43期
2 赵振华;陈枝挺;潘晓东;郑峥;;颅内静脉窦血栓及其脑实质病灶的MRI表现[J];中国脑血管病杂志;2015年10期
3 杨宏志;刘国军;李延静;;3.0T磁共振对静脉性脑梗死的评估[J];中国现代医学杂志;2015年22期
4 李敬伟;王中原;卢正娟;罗云;周建军;庞伟;徐运;;孕产期颅内静脉窦血栓形成的临床特点[J];临床神经病学杂志;2013年05期
5 胡文立;杨磊;;横窦乙状窦血栓形成的诊断与处理[J];中国实用内科杂志;2007年21期
6 王大江;方伯言;魏世辉;;颅内静脉窦血栓形成的眼部临床特点分析[J];中华眼底病杂志;2006年06期
7 李宝民;李生;曹向宇;王君;;出血性脑静脉窦血栓的血管内治疗[J];中华神经外科杂志;2005年12期
8 李存江,王桂红,王拥军,宿英英;脑静脉窦血栓形成的早期诊断与治疗[J];中华神经科杂志;2002年02期
9 冯璞,黄旭升,郎森阳,陈海伦,匡培根;影响颅内静脉窦和脑静脉血栓形成正确诊断的因素与诊断探讨[J];中华神经科杂志;2001年03期
10 须瑞;蒲传强;田成林;杨飞;黄旭升;吴卫平;;单发和多发脑静脉血栓形成的临床特征分析[J];中华神经医学杂志;2010年10期
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