脑静脉／静脉窦血栓形成伴颅内出血患者的临床特点及相关因素

摘要

Objective To investigate the clinical features and the risk factors of intracranial hemorrhage in patients with cerebral venous sinus thrombosis ( CVST) .Methods Patients with CVST admitted to our hospital from January 2006 to May 2016 ,80 consecutive patients with CVST were included .Patients with CSVT were divided into hemorrhagic group and non-hemorrhagic group according to whether intracranial hemorrhage was demonstrated .The clinical characteristics , medical history,etiology and neuroimaging feature were compared .Results Thirty five (43.75%) patients were demon-strated to have intracranial hemorrhage .Seizures(P<0.001),sensorial/motor deficits (P=0.001),language deficits (P=0.033) and consciousness disturbances (P<0.001) were more common in hemorrhagic group ,while hypopsia (P=0.012) was rare.Compared to non-hemorrhagic group,Age of hemorrhagic group was higher ,Univariate analysis proves that advanced age (P=0.023),straight sinus thrombosis(P=0.037),pregnancy or puerperium (P=0.037) and short out-hospital delay(P<0.001) often existed hemorrhagic group,However,CVST scores of the two groups had no statistical sig-nificance .Advanced age ,short out-hospital delay and straight sinus thrombosis were independently associated with intracra -nial hemorrhage after multivariate analysis .Conclusion CVST with advanced age ,pregnancy/puerperim or straight sinus thrombosis was more liable to intracranial hemorrhage .Focal neurological deficit ,seizure and disturbance of consciousness were more in patients with CVST and intracranial hemorrhage .%目的：探讨脑静脉／静脉窦血栓形成（ Cerebral venous sinus thrombosis CVST ）伴颅内出血患者的临床特点及相关因素。方法回顾性分析80例CVST患者，将其分为出血及未出血两组，分析比较两组患者的一般资料、既往病史、潜在病因、临床表现及血栓部位。结果入组80例CVST患者中，出血患者35例（43．75％）。其临床表现以癫痫发作（P＜0．001）、感觉及运动障碍（P＝0．001）、失语（P＝0．033）、意识障碍（P＜0．001）更常见，视力下降患者（P＝0．012）较少。单因素分析显示，与未出血组相比，出血组患者发病年龄较大（P＝0．023），自症状出现至首次就诊时间较短（P＜0．001），妊娠／产褥期（P＝0．037）更多，直窦／深静脉更易受累（P＝0．037）。出血组与未出血组患者的CVST评分差异无统计学意义。多因素分析发现，年龄偏大、急性期入院及直窦／深静脉受累与CVST伴出血的独立相关。结论年龄较大、妊娠／产褥期和直窦受累的CVST患者更易发生颅内出血。合并出血患者局灶性神经功能障碍、癫痫和意识障碍发生率高。