脑静脉窦血栓形成并发性发作的危险因素和对临床转归的影响

摘要

目的：探讨脑静脉窦血栓形成（cerebralvenoussinusthrombosis，CVST）患者继发性发作的危险因素及其对临床转归的影响。方法回顾性纳入CVST患者，收集危险因素、临床表现及影像学资料，对性发作组与非性发作组的资料进行比较。结果共纳入69例CVST患者，其中32例（46．38％）继发性发作。在临床表现方面，性发作组患者更多表现为偏瘫（37．50％对15．63％；χ2＝5．240，P＝0．020）。影像学检查显示，性发作组更多表现为出血（29．41％对10．81％；χ2＝3．818，P＝0．047），损伤部位更多累及额叶（31．25％对10．81％；χ2＝5．008，P＝0．023）和颞叶（43．75％对8．11％；χ2＝7．318，P＝0．005），而且血栓形成部位多见于上矢状窦（65．63％对40．54％；χ2＝4．264，P＝0．036）。多变量logistic回归分析显示，局灶神经功能缺损（优势比5．167，95％可信区间1．993~15．764；P＝0．004）和上矢状窦血栓形成（优势比0．126，95％可信区间0．042~0．370；P＝0．039）是CVST患者继发性发作的独立危险因素。性发作组的院内病死率（6．25％对2．7％；χ2＝0．512，P＝0．469）和90 d 转归良好率（转归良好定义为 Barthel 指数＞60分）（81．25％对86．47％；χ2＝0．346，P＝0．793）与非性发作组无统计学差异。结论存在局灶神经功能缺损和上矢状窦血栓形成是CVST患者继发性发作的独立危险因素，但是否继发性发作与CVST患者的院内死亡风险和90 d临床转归无关。%ObjectiveToinvestigatetheriskfactorsofepilepticseizuresanditseffectonclinical outcome in patients w ith cerebral venous sinus thrombosis (CVST). Methods The patients w ith CVST w ere enrol ed retrospectively. The risk factors, clinical manifestations, and imaging data w ere col ected. The data of an epileptic seizure group and a non-epileptic seizure group w ere compared. Results A total of 69 patients with CVST were enroled, including 32 (46.38%) secondary epileptic seizures. In the aspect of clinical manifestations, more patients show ed hemiplegia in the epileptic seizure group (37.50%vs.15.63%; χ2 =5.240, P=0.020). Imaging examination show ed that more patients in the epileptic seizure group presented w ith bleeding ( 29.41%vs. 10.81%; χ2 = 3.818, P= 0.047 ), more lesion involving frontal lobe (31.25%vs.10.81%; χ2 =5.008, P=0.023), and temporal lobe (43.75%vs.8.11%; χ2 =7.318, P=0.005), and the thrombosis sites w ere more common in the superior sagittal sinuses (65.63%vs.40.54%;χ2 =4.264, P=0.036). Multivariate logistic regression analysis show ed that focal neurological deficits (odds ratio 5.167, 95% confidence interval 1.993-15.764; P=0.004) and superior sagittal sinus thrombosis (odds ratio 0.126, 95% confidence interval 0.042-0.370; P=0.039) w ere the independent risk factors for patients w ith secondary epileptic seizures. There w ere no significant differences in hospital mortality (6.25%vs.2.7%; χ2 =0.512, P=0.469 ) and 90 day 90-day ful recovery rate ( defined as Barthel Index >60) (81.25%vs.86.47%; χ2 =0.346, P=0.793) betw een the epileptic seizure group and the non-epileptic seizure group. Conclusions Focal neurologic deficits and superior sagittal sinus thrombosis are the independent risk factors for secondary epileptic seizures, how ever, secondary epileptic seizures is not associ-ated w ith in-hospital mortality risk and 90-day clinical outcomes in patients w ith CVST.