颅内静脉窦血栓形成患者合并颅内出血性病变的特点及其影响因素

Characteristics and influencing factors of intracranial hemorrhagic lesions in patients with intracranial venous sinus thrombosis

目的探讨颅内静脉窦血栓形成(CVST)患者合并颅内出血性病变的临床特点及其影响因素。方法回顾性分析广西医科大学第一附属医院2013年1月至2020年12月108例CVST患者的临床资料。其中,发生颅内出血性病变46例(出血性病变组),未发生颅内出血性病变62例(无出血性病变组)。记录两组患者的一般病史资料、实验室检查结果、影像学检查结果、入院24 h美国国立卫生研究院卒中量表(NIHSS)评分和出院时(或住院第30天)改良Rankin量表(mRS)评分(2~6分为预后不良)。采用多因素Logistic回归分析影响CVST患者发生颅内出血性病变的独立危险因素及影响CVST合并颅内出血性病变患者预后的独立危险因素。结果出血性病变组NIHSS评分、中性粒细胞与淋巴细胞比值(NLR)、高敏C反应蛋白(hs-CRP)及意识改变、痫性发作、预后不良、口服避孕药、先天性蛋白C或S缺陷比例明显高于无出血性病变组[4(0,10)分比0(0,5)分、4.62(2.50,8.58)比3.46(2.01,5.00)、13.1(5.6,56.7)mg/L比7.5(2.8,18.0)mg/L、47.8%(22/46)比29.0%(18/62)、39.1%(18/46)比21.0%(13/62)、39.1%(18/46)比21.0%(13/62)、32.6%(15/46)比8.1%(5/62)、30.4%(14/46)比12.9%(8/62)],差异有统计学意义(P<0.01或<0.05)。出血性病变组直窦和多个静脉窦血栓发生率明显高于无出血性病变组[43.5%(20/46)比24.2%(15/62)和82.6%(38/46)比58.1%(36/62)],差异有统计学意义(P<0.05或<0.01)。多因素Logistic回归分析结果显示,口服避孕药、多个静脉窦血栓及hs-CRP和NLR升高是影响CVST患者发生颅内出血性病变的独立危险因素(OR=6.950、5.182、1.026和1.137,95%CI 1.453~33.243、1.076~24.960、1.007~1.046和1.004~1.287,P<0.05或<0.01)。46例CVST合并颅内出血性病变患者中,预后良好28例,预后不良组18例。预后不良患者NIHSS评分、NLR、hs-CRP及口服避孕药、先天性蛋白C或S缺陷、意识改变和痫性发作比例明显高于预后良好患者[9(4,28)分比0(0,6)分、7.43(3.86,12.99)比3.30(1.97,6.77)、127.0(96.5,168.0)mg/L比11.5(3.3,33.5)mg/L、10/18比17.9%(5/28)、10/18比14.3%(4/28)、12/18比35.7%(10/28)和11/18比25.0%(7/28)],差异有统计学意义(P<0.01或<0.05)。多因素Logistic回归分析结果显示,hs-CRP升高是影响CVST合并颅内出血性病变患者预后的独立危险因素(OR=1.046,95%CI 1.007~1.086,P<0.05)。结论CVST合并颅内出血性病变患者临床症状更重,意识改变、痫性发作、短期预后不良更常见;口服避孕药、多个静脉窦受累及NLR和hs-CRP升高是CVST患者发生颅内出血性病变的独立危险因素;而且hs-CRP升高还是CVST合并颅内出血性病变患者短期预后不良的独立危险因素。

Objective To explore the clinical characteristics and influencing factors intracranial hemorrhagic lesions in patients with intracranial venous sinus thrombosis(CVST).Methods The 108 patients with CVST from January 2013 to December 2020 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.Among them,46 patients had intracranial hemorrhagic lesions(hemorrhagic lesion group),and 62 patients did not have intracranial hemorrhagic lesions(non hemorrhagic lesion group).The general medical history data,laboratory examination results,imaging examination results,National Institutes of Health stroke scale(NIHSS)score within 24 hours of admission and modified Rankin scale(mRS)score(2 to 6 scores indicating poor prognosis)at discharge(or on the 30th day of hospitalization)were recorded.Multivariate Logistic regression analysis was used to analyze the independent risk factors of intracranial hemorrhagic lesions in patients with CVST and the independent risk factors of prognosis in patients CVST combined with intracranial hemorrhagic lesions.Results The NIHSS score,neutrophil to lymphocyte ratio(NLR),high sensitivity C-reactive protein(hs-CRP)and the proportions of changes in consciousness,epileptic seizures,poor prognosis,oral contraceptives,congenital protein C or S deficiency in hemorrhagic lesion group were significantly higher than those in non hemorrhagic lesion group:4(0,10)scores vs.0(0,5)scores,4.62(2.50,8.58)vs.3.46(2.01,5.00),13.1(5.6,56.7)mg/L vs.7.5(2.8,18.0)mg/L,47.8%(22/46)vs.29.0%(18/62),39.1%(18/46)vs.21.0%(13/62),39.1%(18/46)vs.21.0%(13/62),32.6%(15/46)vs.8.1%(5/62),30.4%(14/46)vs.12.9%(8/62),and there were statistical differences(P<0.01 or<0.05).The incidences of straight sinus and multiple venous sinus thrombosis in hemorrhagic lesion group were significantly higher than those in non hemorrhagic lesion group:43.5%(20/46)vs.24.2%(15/62)and 82.6%(38/46)vs.58.1%(36/62),and there were statistical differences(P<0.05 or<0.01).Multivariate Logistic regression analysis result showed that the oral contraceptives,multiple venous sinus thrombosis and the elevated hs-CRP,NLR were independent risk factors of intracranial hemorrhagic lesions in patients with CVST(OR=6.950,5.182,1.026 and 1.137;95%CI 1.453 to 33.243,1.076 to 24.960,1.007 to 1.046 and 1.004 to 1.287;P<0.05 or<0.01).Among 46 patients with CVST combined with intracranial hemorrhagic lesions,28 patients had a good prognosis,and 18 patients had a poor prognosis.The NIHSS score,NLR,hs-CRP and the proportions of oral contraceptives,congenital protein C or S deficiency,changes in consciousness and epileptic seizures in patients with poor prognosis were significantly higher than those in patients with good prognosis:9(4,28)scores vs.0(0,6)scores,7.43(3.86,12.99)vs.3.3(1.97,6.77),127.0(96.5,168.0)mg/L vs.11.5(3.3,33.5)mg/L,10/18 vs.17.9%(5/28),10/18 vs.14.3%(4/28),12/18 vs.35.7%(10/28)and 11/18 vs.25.0%(7/28),and there were statistical difference(P<0.01 or<0.05).Multivariate Logistic regression analysis result showed that the elevated hs-CRP was the independent risk factor of prognosis in patients CVST combined with intracranial hemorrhagic lesions(OR=1.046,95%CI 1.007 to 1.086,P<0.05).Conclusions The patients with CVST combined with intracranial hemorrhagic lesions have more severe clinical symptoms,and the changes in consciousness,epileptic seizures,poor short-term prognosis are more common.The oral contraceptives,multiple venous sinus involvement and elevated NLR,hs-CRP are independent risk factors in patients with CVST combined with intracranial hemorrhagic lesions;moreover,the elevated hs-CRP is an independent risk factor for poor short-term prognosis in patients with CVST combined with intracranial hemorrhagic lesions.