溃疡性结肠炎合并脑静脉系统血栓形成的临床分析

Clinical analysis of ulcerative colitis complicated with cerebral venous thrombosis

目的 研究溃疡性结肠炎(ulcerative coliti, UC)合并脑静脉系统血栓形成(cerebral venous thrombosis, CVT)的临床特点,提高对UC合并CVT的认识。方法 回顾性分析在我院诊治的18例UC合并CVT患者的临床资料,并选择同期在我院住院诊治的无CVT并发症的UC患者共54例作为对照组,两组患者之间性别、年龄、病程相匹配,采用t检验或χ^(2)检验进行统计学分析,并采用Logistic回归分析UC合并CVT的危险因素。结果 UC合并CVT患者中,男性发生率高(66.7%),中位病程4.75年(2~7.25年),重度UC(10/18)、全结肠型(12/18)多见,神经系统症状主要为头痛、头晕(10/18),呕吐(3/18)、视物模糊(2/18)、肢体(2/18)及言语障碍(2/18),单纯出现嗜睡症状易被忽视。CVT部位以横窦多见(11/18),也可表现为多部位血栓(6/18)。低蛋白血症、血小板增多是UC合并CVT的危险因素。采用以低分子肝素为主的抗凝治疗后,17例患者好转,1例死于多器官功能衰竭。UC合并CVT的预后要比UC未合并CVT预后差。结论 低蛋白血症、血小板增多是UC合并CVT的危险因素,采用低分子肝素为主的治疗可能预防及治疗UC合并CVT。

Objective To investigate the clinical course of ulcerative coliti(UC)patients who develop cerebral vascular thrombosis(CVT).Methods The clinical data of 18 UC patients with CVT were analyzed retrospectively.UC patients without CVT was selected as the control group.Sex,age and course between the two groups were matched.For univariate analysis,t-test andχ^(2) test were used for statistical analysis,and Logistic regression analysis was used to identify risk factors of cerebrovascular embolism.Results Median duration of UC was 4.75 years(2-7.25 years)when cerebrovascular events occurred,with a high incidence of male prevalence(66.7%).Severe UC with total colonic involvement(12/18)was predominant.Cerebral infraction could present with headaches or dizziness(10/18),vomiting(3/18),blurred vision(2/18),speech impairment(2/18)and limb dysmetria(2/18).Drowsiness only might be neglected.Cerebral embolism often occurred in lateral sinus(11/18)even multiple sites(6/18).Hypoproteinemia and increased platelet count were risk factors for UC complicated with cerebrovascular thrombosis.After anticoagulant therapy with low molecular weight heparin,17 patients improved and 1 patient died of multiple organ failure.The prognosis of UC with CVT was worse than that without CVT.Conclusion Hypoproteinemia and thrombocytosis are risk factors of UC complicated with CVT.Low molecular weight heparin therapy may prevent and treat UC complicated with CVT.