基于个性化延迟旋转造影的脑静脉侧支循环分级临床研究

Clinical study of the cerebral collateral venous circulation scale based on individualized delayed rotational phlebography

目的探讨脑静脉血栓形成(CVT)患者不同分级静脉侧支循环与症状、脑实质损伤、预后等临床资料的相关性。方法回顾性分析2011年12月至2018年8月南方医科大学第三附属医院确诊的CVT患者的临床和影像资料。共纳入32例CVT患者,男19例,女13例,年龄20~60(39±12)岁。所有患者均行全脑血管造影、个性化延迟旋转造影,将静脉侧支循环分为4类,根据侧支循环的数量、直径以及对比剂的流空延迟的现象,制定脑静脉侧支循环量表(CVCS),并分为3级。CVCS 0级9例,CVCS 1级13例,CVCS 2级10例,记录所有患者的临床资料(危险因素、病程、临床症状)、影像资料(脑实质损伤、血栓部位)、治疗(血管内治疗、去骨瓣减压手术)和预后。比较不同CVCS分级患者临床资料、影像表现、脑实质损伤、预后之间的差异,并采用Gamma法或Spearman相关分析法比较差异有统计学意义的变量与CVCS分级之间的相关性。结果32例CVT患者中,出现神经功能缺损19例,脑实质损伤17例。不同CVCS分级患者比较,病程、神经功能缺损、局灶性运动障碍、语言功能障碍、意识障碍、孤立性头痛、深静脉血栓、皮层静脉血栓、预后组间差异均有统计学意义(P<0.05)。相关性分析结果显示CVCS分级与病程、孤立性头痛呈正相关(r=0.724、0.637,P<0.001),与神经功能缺损症状、局灶性运动障碍、意识障碍、脑实质损伤、深静脉血栓呈负相关(r=-0.797、-0.451、-0.782、-0.697、-0.427,P<0.05)。第90天随访结果显示mRS 0分18例,mRS 1分6例,mRS 2~4分各2例,mRS 5~6分各1例,CVCS分级与第90天的mRS评分呈负相关(r=-0.732,P<0.001)。结论CVT患者脑静脉侧支循环越差,脑实质损伤及神经功能缺损症状的发生率越高,临床预后越差。

Objective To investigate the correlation between venous collateral circulation and clinical data such as symptoms,parenchymal injury,and prognosis in patients with cerebral venous thrombosis(CVT).Methods The clinical and imaging data of patients with CVT diagnosed in the department of Neurosurgery of the Third Affiliated Hospital of Southern Medical University from December 2011 to August 2018 were retrospectively analyzed.A total of 32 patients with CVT were included,19 males and 13 females,aged from 20 to 60(39±12)years.All patients underwent cerebral angiography,individualized delayed rotational phlebography.According to the number and diameter of collateral circulation and the phenomenon of flow delay of contrast medium,the collateral venous circulation scale(CVCS)was developed and divided into 3 levels.The clinical data(risk factors,course of disease,clinical symptoms),imaging data(parenchymal injury,thrombus site),treatment(endovascular treatment,decompressive craniectomy)and prognosis of all patients were recorded.The differences in clinical data,imaging appearances,parenchymal injury,and prognosis between patients with different CVCS were compared,and the correlation between variables with statistically significant differences and CVCS was compared using the Gamma method or Spearman correlation analysis.Results Among the 32 patients with CVT,9 were CVCS 0,13 were CVCS 1 and 10 were CVCS 2.Among them,there were 19 cases of neurological deficit and 17 cases of brain parenchymal injury.There were significant differences in course of disease,neurological deficit,focal dyskinesia,language dysfunction,consciousness disorder,isolated headache,deep vein thrombosis,cortical vein thrombosis and prognosis across different CVCS(P<0.05).Correlation analysis showed that CVCS was positively correlated with course of disease and isolated headache(r=0.724,0.637,P<0.001),and negatively correlated with neurological deficit symptoms,focal dyskinesia,disturbance of consciousness,brain parenchymal injury and deep vein thrombosis(r=-0.797,-0.451,-0.782,-0.697,-0.427,P<0.05).The results of 90 days follow-up showed that there were 18 cases with mRS 0,6 cases with mRS 1,2 cases with mRS 2-4,and 1 case with mRS 5-6 points.There was a negative correlation between CVCs grading and mRS score at 90 days(r=-0.732,P<0.001).Conclusion Lower cerebral venous collateral circulation grade is associated with higher incidence of brain parenchymal injury,neurological deficit symptoms,and worse clinical prognosis.