脑静脉／静脉窦血栓形成患者易发脑出血的因素分析

Clinical features and risk factors of intracranial hemorrhage in patients with cerebral venoussinus thrombosis

目的分析脑静脉／静脉窦血栓形成（CVST）合并脑出血患者在临床表现、致病因素和血栓累及部位等方面的特点。方法选择自2013年1月至2016年12月在南阳市中心医院神经内科诊治的87例CVST患者，将其中39例出现脑出血和48例未出现脑出血的患者分别设为观察组和对照组，对2组的一般资料、临床症状、致病因素、血栓累及静脉／静脉窦部位等进行比较，然后采用多因素Logistic回归分析确定CVST合并脑出血的独立影响因素。结果临床症状方面，观察组患者出现视力下降（35．9％）、癫痫发作（48．7％）、运动／感觉障碍（46．2％）、意识改变（25．6％）、失语（12．8％）的比例明显高于对照组（12．5％、16．7％、18．8％、8．3％、0％），差异有统计学意义（P〈0．05）；潜在致病因素方面，观察组妊娠／产褥期所占比例（20．6％1明显高于对照组（6．3％），差异有统计学意义似O．05）；血栓累及静脉／静脉窦部位方面，观察组患者累及直窦所占的比例（30．8％）明显高于对照组（12．5％），差异有统计学意义伴0．05）。多因素Logistic回归分析结果显示，妊娠／产褥期、血栓累及直窦是cvST合并脑出血的独立影响因素（OR=6．752，95％CI：2．295～16．213，P=0．017；OR=4．573，95％CI：1．316～11．751，P=-0．029）。结论妊娠／产褥期及血栓累及直窦的CVST患者更容易合并脑出血症状，应当尽早给予针对性治疗。

Objective To analyze the clinical features, pathogenic factors and sites ofthrombus involvement in patients with cerebral venous/venous sinus thrombosis （CVST） complicated with cerebral hemorrhage. Methods Eighty-seven patients with CVST, admitted to our hospital from January 2013 to December 2016, were selected and divided into observation group （n=39） and control group （n=48） according to cerebral hemorrhage. The demographic data, clinical features, pathogenic factors, and location of the involved venous/venous sinus were compared and analyzed between the two groups. The independent influencing factors of CVST combined with intracerebral hemorrhage were assessed using multivariable Logistic regression. Results Percentages of patients with decreased visual acuity （35.9%）, epileptic seizure （48.7%）, motor/sensory disorders （46.2%）, consciousness changes （25.6%） and aphasia （12.8%） of the observation group were significantly higher than those of the control group （12.5%, 16.7%, 18.8%, 8.3%, and 0%, /9〈0.05）. In the aspect of potential pathogenic factors, the proportion of patients at pregnancy/puerperium in the observation group （20.6%） was significantly higher than that in the control group （6.3%, P〈0.05）. In the aspect of involving venous/venous sinus area, the proportion of patients involved in straight sinus in the observation group （30.8%） was significantly higher than that in the control group （12.5%, P〈0.05）. Multivariate Logistic analysis showed that pregnancy/puerperium and involvement of straight sinus were the independent influencing factors of CVST combined with cerebral hemorrhage （OR=6.752, P=-0.017, 95%CI： 2.295-16.213; OR=4.573, P=-0.029, 95%CI： 1.316-11.751）. Conclusion CVST patients at pregnancy/postpartum or with straight sinus thrombosis are more prone to cerebral hemorrhage, and targeted treatment should be given as soon as possible.