【摘要】：目的分析比較156例確診為顱內靜脈竇血栓形成患者的臨床及影像學特征。收集所有入組患者的臨床及影像學資料,并對繼發(fā)腦實質損傷患者可能存在的相關因素(如性別,年齡,平均住院時間,起病急緩,已知病因,臨床表現(xiàn)差異,實驗室檢查結果,血栓累及靜脈竇部位、數(shù)目和短期預后等情況)進行統(tǒng)計學分析比較。為提高靜脈竇血栓形成患者的臨床診療水平。方法回顧性分析所有入組的156例患者的臨床資料,并根據(jù)顱腦CT或MRI影像學檢查結果,分為腦實質病灶陽性組(82例)和陰性組(74例),比較分析兩組患者的一般情況、病因、臨床表現(xiàn)、影像學檢查、受累靜脈竇及短期預后的差異。結果兩組患者單因素比較,顱內靜脈系統(tǒng)血栓形成的病因主要為感染、妊娠、血液系統(tǒng)疾病及代謝、自身免疫性疾病等,陽性組血液系統(tǒng)疾病(包括貧血、血小板增多或減少、白血病、MDS等)患者居多,陰性組患者繼發(fā)于局部感染及術后脫水患者居多;在臨床表現(xiàn)方面,陽性組發(fā)生癲癇、意識障礙、精神癥狀、神經(jīng)功能缺損(包括單側運動障礙、中樞性面舌癱、言語功能障礙)、查體示病理征陽性的比率均高于陰性組,均有顯著性差異(P0.05);據(jù)統(tǒng)計,陽性組血栓形成發(fā)生于上矢狀竇的比率低于陰性組(?2=4.480,P=0.034);DSA檢查可發(fā)現(xiàn)MRV不能明確的病因,如動靜脈畸形、先天性靜脈及靜脈竇發(fā)育不良等;出院時陽性組癥狀完全恢復(改良Rankin評分0~2分)的比率低于陰性組(?2=19.765,P=0.000);二元多因素Logistic回歸分析示陽性組患者意識障礙更重,累及上矢狀竇者更少,短期預后更差。結論1、顱內靜脈系統(tǒng)血栓形成的病因主要為感染、妊娠、血液系統(tǒng)疾病及代謝、自身免疫性疾病等;且合并血液系統(tǒng)疾病患者更容易累及腦實質損傷。2、DSA檢查可發(fā)現(xiàn)MRV檢查不能明確的腦血管畸形及靜脈竇先天發(fā)育不良等潛在病因,對此病的病因學診斷意義重大,還可以了解管腔閉塞程度及側支循環(huán)建立情況,建議臨床有條件者應盡量積極行DSA檢查。
[Abstract]:Objective to analyze and compare the clinical and imaging features of 156 patients with intracranial venous sinus thrombosis. The clinical and imaging data of all the patients were collected, and the possible related factors (such as sex, age, average hospitalization time, onset of onset, known etiology, clinical manifestation differences, laboratory examination results, thrombus involved in venous sinus, number and short-term prognosis) were statistically analyzed and compared among the patients with secondary brain parenchyma injury (such as sex, age, average hospitalization time, onset of onset, known etiology, clinical manifestation difference, laboratory examination results, thrombus involved in venous sinus, number and short-term prognosis, etc.). In order to improve the clinical diagnosis and treatment of patients with venous sinus thrombosis. Methods the clinical data of all patients were analyzed retrospectively. according to the results of CT or MRI imaging examination, they were divided into positive group (82 cases) and negative group (74 cases). The general situation, etiology, clinical manifestations, imaging examination, involved venous sinus and short-term prognosis of the two groups were compared and analyzed. Results the main causes of intracranial venous thrombosis were infection, pregnancy, blood system disease and metabolism, autoimmune diseases and so on. Most of the patients in the positive group had blood system diseases (including anemia, platelet increase or decrease, leukemia, MDS, etc.), and most of the patients in the negative group were secondary to local infection and postoperative dehydration. In terms of clinical manifestations, seizures, disturbance of consciousness, mental symptoms and neurological defects (including unilateral motor disorder, central facial tongue paralysis, speech dysfunction) in the positive group were significantly higher than those in the negative group (P < 0.05). According to statistics, the incidence of thrombosis in the superior sagittal sinus in the positive group was lower than that in the negative group (? 2: 4.480, P 鈮，

本文編號：2504112