Zhongguo cuzhong zazhi (Jul 2023)
妊娠合并颅内静脉窦血栓形成的临床特征及其预后相关因素研究 Clinical Features of Cerebral Venous Sinus Thrombosis during Pregnancy and Study of Its Prognostic Related Factors
Abstract
目的 探讨妊娠合并颅内静脉窦血栓形成（cerebral venous sinus thrombosis，CVST）患者与非妊娠CVST女性患者的临床特征差异，以及妊娠合并CVST预后的影响因素。 方法 回顾性连续纳入2006年1月—2021年6月在首都医科大学附属北京天坛医院住院治疗的妊娠期和产褥期（产后6周内）CVST患者（妊娠合并CVST组），以同期住院的非妊娠期或产褥期女性CVST患者为对照（非妊娠CVST组），比较两组临床特征。根据妊娠合并CVST组患者出院3个月复查时的mRS评分，将其分为预后良好（mRS评分＜3分）和预后不良（mRS评分≥3分）组，采用多因素logistic回归分析妊娠合并CVST预后不良的影响因素。 结果 研究纳入妊娠合并CVST患者43例，非妊娠CVST女性患者44例。妊娠合并CVST组高凝状态（高脂血症、高纤维蛋白原血症和血小板增多症）、贫血、首发症状出现肌力下降、癫痫、意识不清的比例高于非妊娠CVST组，mRS评分高于非妊娠CVST组，视力受损、血管内溶栓和机械取栓的比例低于非妊娠CVST组，差异均有统计学意义。logistic回归分析结果显示，首发症状为癫痫（OR 1.08，95%CI 1.06～1.12，P=0.01）、合并脑出血（OR 6.46，95%CI 2.50～16.69，P＜0.01）和妊娠高血压（OR 9.01，95%CI 2.27～35.70，P＜0.01）是妊娠合并CVST患者预后不良的危险因素。 结论 首发症状为癫痫、合并脑出血和妊娠高血压是妊娠合并CVST患者预后不良（mRS评分≥3分）的独立危险因素。 Abstract: Objective To investigate the difference of clinical features between pregnant women with cerebral venous sinus thrombosis (CVST) and non-pregnant CVST, and the factors influencing the prognosis of pregnant women with CVST. Methods Retrospectively, patients with combined CVST in pregnancy and puerperium (within 6 weeks postpartum) hospitalized at Beijing Tiantan Hospital, Capital Medical University from January 2006 to June 2021 were included in the combined pregnancy and CVST group, and female patients with CVST who were not in pregnancy or puerperium were included in the non-pregnant CVST group. Clinical characteristics of the two groups were compared. Based on the results of the mRS score at the first review at 3 months after the end of hospitalization, the pregnant patients with CVST were divided into good prognosis (mRS<3) and poor prognosis (mRS≥3) groups, and multifactorial logistic regression analysis was used to explore the factors associated with the poor prognosis of such patients. Results The study included 43 patients with combined pregnancy CVST and 44 in the non-pregnant CVST. The rates of hypercoagulability (hyperlipidemia, hyperfibrinogenemia and thrombocythemia), anemia, first symptom presenting with loss of limb strength, epilepsy, and confusion were higher in the combined pregnancy CVST group than in the non-pregnancy CVST group, the mRS at discharge was higher than that in the non-pregnancy CVST group, and the rates of impaired vision and endovascular thrombolysis and mechanical fragmentation were lower than those in the non-pregnancy CVST group, which were statistically significant. The results of logistic regression analysis showed that epilepsy (OR 1.08, 95%CI 1.06-1.12, P=0.01), combined cerebral hemorrhage (OR 6.46, 95%CI 2.50-16.69, P<0.01), and hypertensive disorders of pregnancy (OR 9.01, 95%CI 2.27-35.70, P<0.01) were the risk factors for poor prognosis of pregnant patients with CVST. Conclusions Epilepsy, combined cerebral hemorrhage, and hypertensive disorders of pregnancy were independent risk factors for poor prognosis (mRS≥3) in pregnant patients with CVST.
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