脑静脉窦血栓再通对临床预后的影响

Impact of recanalization of cerebral venous sinus thrombosis on clinical prognosis

目的探讨脑静脉窦血栓经抗凝治疗后的再通情况及再通对长期预后的影响。方法对63例首次诊断CVST患者进行抗凝治疗,分别于出院时、出院后第3个月、第6个月和第12个月对患者进行MRI联合MRV复查,根据MRV和MRI结果 ,分为完全再通、部分再通和未通,使用改良Rankin量表(mRS)对患者预后评分。根据mRS评分,将患者分为完全恢复和不完全恢复组(mRS=0分为完全恢复,mRS 1~6分为不完全恢复);预后良好组和预后不良组(mRS≤2为预后良好,mRS>2为预后不良)。采用Logistic回归分析相关因素对长期预后的影响。结果出院时(18±4)d、出院后第3个月、第6个月和第12个月的再通率分别是60%、73%、79%和81%。出院第12个月时,完全再通32例(51%),部分再通19例(30%);39例(62%)患者完全恢复,24例(38%)患者不完全恢复。单因素分析显示,年龄≥40岁、静脉窦未通是CVST不完全恢复的危险因素。多因素Logistic回归分析显示,只有年龄≥40岁(OR=5.995,95%CI:1.195~20.922;P=0.023)是CVST不完全恢复的独立危险因素。完全再通患者预后明显好于未通患者(HR=3.17,95%CI:1.8~10.43;P<0.001)。年龄≥40岁、男性、未通是CVST预后不良的危险因素,多因素Logistic回归分析显示,年龄≥40岁(OR=6.675,95%CI:2.195~8.922;P=0.035)是预后不良的独立危险因素,而未通不是预后不良的独立危险因素(OR=2.843,95%CI:0.87~13.472;P=0.11)。结论脑静脉窦血栓形成闭塞静脉窦的再通呈时间依赖性,完全再通患者预后好于未通患者。

Objective To investigate the recanalization of cerebral venous sinus thrombosis（ CVST） after anticoagulant therapy and its impact on long-term prognosis. Methods A total of 63 patients newly diagnosed with CVST were treated with anticoagulant therapy.The patients were re-examined with magnetic resonance imaging（ MRI） combined with magnetic resonance venography（ MRV） at the time of discharge and in the 3 th,6 th,and 12 th months after discharge. According to the results of MRI and MRV,the outcome of CVST was divided into complete recanalization,partial recanalization,and failure. The modified Rankin Scale（ mRS） was used to assess the prognosis of patients. According to the mRS score,the patients were divided into complete recovery group（ mRS = 0） and incomplete recovery group（ mRS = 1-6）,as well as good prognosis group（ mRS≤2） and poor prognosis group（ mRS〉2）. Logistic regression analysis was used to determine the impact of related factors on long-term prognosis. Results The recanalization rates at the time of discharge（ 18±4 days after anticoagulation） and in the 3 th,6 th,and 12 th months after discharge were 60%,73%,79%,and81%,respectively. In the 12 th month after discharge,32 patients（ 51%） had complete recanalization,and 19 patients（ 30%） had incomplete recanalization; 39 patients（ 62%） recovered completely,and 24 patients（ 38%） recovered incompletely. Univariate analysis showed the age ≥40 years and non-recanalization were risk factors for incomplete recovery from CVST. Multivariate logistic regression analysis indicated that only age ≥40 years was the independent risk factor for incomplete recovery from CVST（ odds ratio [OR]= 5.995,95% confidence interval [CI]： 1.195-20.922; P = 0.023）. Patients with complete recanalization had better prognosis than those without recanalization（ hazard ratio [HR]= 3.17,95%CI： 1.8-10.43; P〈 0.001）. Univariate analysis showed that age ≥40 years,male sex,and non-recanalization were risk factors for poor prognosis of CVST. Multivariate logistic regression analysis showed that only age ≥40 years was the independent risk factor for poor prognosis（ OR = 6.675,95%CI： 2.195-8.922; P = 0.035）,while non-recanalization was not（ OR = 2.843,95%CI： 0.87-13.472; P = 0.11）.Conclusions The recanalization of the occluded venous sinus caused by CVST is time-dependent,and patients with complete recanalization have better prognosis than those without recanalization.