脑静脉窦血栓形成患者短期转归不良的预测因素:回顾性病例系列研究

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 回顾性分析连续入院的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,将患者分为转归良好组(0～2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.采用受试者工作特征(receiver operating characteristic,ROC)曲线分析确定其预测价值.结果 共纳入42例CVST患者,其中29例(69.05％)转归良好,13例(30.95％)转归不良.转归良好组中枢神经系统感染(20.69％对61.54％;x2=6.740,P =0.009)、恶性肿瘤(6.90％对38.46％;x2=6.439,P=0.011)、妊娠、产褥期、口服避孕药或激素替代治疗(6.90％对38.46％;χ2 =6.439,P=0.011)、高同型半胱氨酸血症(27.59％对76.92％;x2=8.922,P =0.003)患者的构成比和基线D-二聚体水平[(730±240) ng/ml对(1 060±250) ng/ml; =4.485,P=0.000]显著性低于转归不良组,治疗方式(x2=11.274,P=0.004)与转归不良组存在显著性差异,转归良好组抗凝、溶栓和抗凝+溶栓的患者比例分别为13.79％、24.14％和62.07％,转归不良组分别为61.54％、23.08％和15.39％.多变量logistic回归分析显示,基线D-二聚体水平＞990 ng/ml是CVST患者短期转归不良的独立预测因素[优势比(odds ratio,OR)1.006,95％可信区间(confidence interval,CI)1.002～1.011;P=0.005],抗凝+溶栓治疗是CVST患者短期转归不良的独立保护因素(OR 0.027,95％ CI 0.002 ～ 0.447;P=0.033).ROC曲线分析显示,基线D-二聚体截断值为990 ng/ml时,其预测CVST短期转归不良的敏感性和特异性分别为76.9％和86.2％.结论 基线D-二聚体水平＞ 990 ng/ml是CVST患者短期转归不良的独立预测因素;CVST患者实施抗凝联合溶栓治疗的效果最佳.%Objective To investigate the predictive factors of short-term poor outcome in patients with cerebral venous sinus thrombosis (CVST).Methods The clinical data of 42 consecutive inpatients with CVST were analyzed retrospectively.The clinical outcomes were assessed with the modified Rankin scale (mRS) at discharge.The patients were divided into either a good outcome group (mRS 0 to 2) or a poor outcome group (mRS 3 to 6).The related factors,such as demographic,etiology,and clinical features were compared between the two groups,Multivariate logistic regression analysis was used to determine the independent predictive factors for short-term poor outcome in patients with CVST.Results A total of 42 patients with CVST were enrolled,29 of them (69.05％) had good outcome and 13 (30.95％) had poor outcome.The proportions of central nervous system infections (20.69％ vs.61.54％ ; x2 =6.740,P =0.009),cancer (6.90％ vs.38.46％ ;x2 =6.439,P =0.011),pregnancy,postpartum,oral contraceptives or hormone replacement therapy (6.90％ vs.38.46％ ; x2 =6.439,P =0.011),and high homocysteine hyperlipidemia (27.59％ vs.76.92％ ;x2 =8.922,P =0.003),as well as the baseline D-dimer levels (730 ± 240 ng/ml vs.1 060 ± 250 ng/ml; t =4.485,P =0.000) in patients of the good outcome group were significantly lower than those of the poor outcome group.There was significant difference in treatment modalities (x2 =11.274,P =0.004) with the poor outcome group.The proportions of patients in anticoagulants,thrombolysis and anticoagulants + thrombolysis were 13.79％,24.14％,and 62.07％,respectively,in the good outcome group,while those were 61.54％,23.08％,and 15.39％,respectively,in the poor outcome group.Multivariate logistic regression analysis showed that the baseline D-dimer level ＞990 ng/mL was an independent predictive factor for short-term poor outcome in patients with CVST (odds ratio [OR] 1.006,95％ confidence interval [CI] 1.002-1.011; P=0.005).Anticoagulants + thrombolytic therapy was an independent protective factor for short-term poor outcome in patients with CVST (OR 0.027,95％ CI 0.002-0.447; P=0.033).The ROC curve analysis showed that when the cutoff value of the baseline D-dimer was 990 ng/ml,the sensitivity and specificity of predicting short-term poor outcome of CVST were 76.9％ and 86.2％ respectively.Conclusions The level of baseline D-dimer ＞990 ng/ml is an independent predictive factor for short-term poor outcomes in patients with CVST.The effect of anticoagulants in combination with thrombolytic therapy is best in patients with CVST.