北京协和医院静脉窦血栓患者临床特点及治疗的变化

Changes in cfinical charcateristics and treatment of cerebral venous and sinus thrombosis： analysis of 35 patients admitted in Peking Union Medical College Hospital

目的观察2001年至今北京协和医院诊治的脑静脉窦血栓形成（CVST）患者病因、临床表现、诊治方式与20世纪90年代的区别。方法回顾1991年1月至2007年6月间35例CVST患者的资料，以2000年12月31日为界，分为A组（20世纪90年代）和B组（2001年后）两组进行比较。结果（1）病因：A组以感染、血液系统异常多见。B组免疫系统异常、血液系统异常多见。（2）临床表现：CVST各症状阳性率为头痛86％，局灶性体征40％，意识障碍31％，癫痫发作34％，视力改变43％，眼底水肿60％；各症状完全缓解率由高到低依次为头痛、意识障碍、癫痫发作、局灶性体征、视力障碍；两组间各症状阳性率及缓解率差异均无统计学意义。（3）治疗：抗凝治疗A组有6例（38％），B组15例（79％），两组间差异有统计学意义。A组无溶栓患者，B组有4例行溶栓治疗。结论2001年后北京协和医院就诊的CVST患者的病因构成有改变，但临床特点没有明显变化；治疗上抗凝和溶栓治疗增多。

Objective To investigate the differences in etiology, symptoms, treatment, and prognosis between the patients with cerebral venous and sinus thrombosis （CVST） before December 31 2000 and those after that date. Methods The etiology, symptom, treatment, and prognosis of the 35 CVST patients admitted to Peking Union Medical College Hospital （PUMC） from January 1 1991 to December 31 2000 （Group A, n = 16） and those admitted from January 1 2000 to May 31 2007 （ Group B, n = 19） were analyzed and compared. Results （ 1 ） The first two common causes were infection and hematological disease in Group A, while the first two common causes were immune disease and hematological disease in Group B. （2） The common symptoms and signs and positive rates were as follows： headache （86%）, seizures （34%）, focal neurological deficits （40%） , vision deficits （43%）, altered consciousness （31%）, and papilloedema （60%） without significant differences between these 2 groups. The positive rates of the common symptoms and signs during discharge were as follows： headache （77%）, altered consciousness （73%） , seizures （ 67% ） , focal neurological deficits （ 57% ）, vision deficits （ 43% ）, and altered consciousness （31%） without significant differences between these 2 groups. （3） 38% of the patients in Group A（ n = 6）received anticoagulation therapy, a rate significandy lower than that of Group B （79%, n = 19） （P 〈 0. 05 ）. Four patients in Group B received thrombolytic therapy. Conclusion The etiological constituents of CVST patients admitted in PUMC has changed, the weight of infection has declined and that of the immune disease has risen. The spectrum of signs remains unchanged; however, the rate of anticoagulation has ascended.