颅内静脉窦血栓形成163例的临床特点及预后分析

Analysis of clinical features and prognosis of 163 cerebral venous sinus thrombosis

目的 探讨颅内静脉窦血栓形成（cerebral venous sinus thrombosis,CVST）的临床特点、预后及其影响因素.方法 回顾性分析163例CVST患者的临床资料,随访预后情况并使用改良Rankin量表（modified Rankin Scale,mRS）评分评价预后.采用Logistic回归分析相关因素对CVST预后的影响.结果 163例CVST患者中,头痛140例,运动和（或）感觉障碍16例,昏迷6例,治疗前颅内压＞350 mm H2O（1 mm H2O =0.0098 kPa） 68例,侧窦血栓129例,直窦血栓11例,出血性卒中21例.成功随访150例（92％）,mRS评分：0～1分89例,2分13例,3～5分44例,6分4例.预后不良（mRS＞2分）48例（29.4％）,死亡4例（2.7％）.单因素分析显示：运动和（或）感觉障碍、直窦血栓、治疗前颅内压＞ 350 mm H2O、出血性卒中是CVST预后不良的危险因素.多因素Logistic回归分析显示：治疗前颅内压＞350 mm H2O（OR=0.169,95％ CI0.053 ～0.541,P=0.003）、出血性卒中（OR=0.075,95％ CI0.018～0.311,P=0.000）是CVST预后不良的独立危险因素.结论 CVST临床表现复杂多变,缺少特异性.目前在我国仍有一定的致死、致残率.治疗前颅内压＞ 350 mm H2O、出血性卒中是CVST预后不良的独立危险因素.

Objective To investigate the clinical features, prognosis and its influencing factors of cerebral venous sinus thrombosis （CVST）. Methods The clinical data of 163 patients with CVST were analyzed retrospectively. The outcome was assessed with the modified Rankin Scale （mRS）. The influencing factors on prognosis were analyzed by logistic regression model. Results Among the 163 CVST cases, headache was found in 140 cases, motor and （or） sensory deficits in 16 cases, coma in 6 cases, serious intracranial hypertension （ 〉350 mm H20, 1 mm H20 =0. 0098 kPa） in 68 cases, lateral sinus thrombosis in 129 cases, straight sinus thrombosis in 11 cases and intracranial hemorrhage in 21 cases. Follow-up data was obtained by telephone in 150 cases （92%）. The mRS scores were 0--1 in 89 cases, 2 in 13 cases, 3--5 in 44 cases, and 6 in 4 cases respectively. Poor outcome （ mRS score 〉 2 ） was found in 29.4% （48/163） patients. The total mortality rate was 2. 7% （4/150）. Univariate analysis identified factors associated with poor outcome were motor and （or） sensory deficits, straight sinus thrombosis, serious intracranial hypertension （ 〉 350 mm H20 ） and intracranial hemorrhage. In logistic regression analysis, serious intracranial hypertension （ 〉 350 mm H20 ; OR = 0. 169, 95% CI O. 053--0. 541, P = 0. 003 ） and intracranial hemorrhage （ OR = 0. 075, 95 % CI 0. 018---0. 311, P = 0. 000 ） were identified as independent predictors of poor prognosis. Conclusions The clinical manifestations of CVST are complicated and nonspecific. It is still a disease that may lead to death or disability. Serious intracranial hypertension（ 〉 350 mm H20） and intracranial hemorrhage were independent predictors of poor prognosis.