腦靜脈系統(tǒng)血栓形成的早期診斷及臨床特征分析
發(fā)布時(shí)間：2018-07-26 20:37
【摘要】：第一部分影響腦靜脈系統(tǒng)血栓形成早期診斷的相關(guān)因素分析目的:由于CVT的癥狀、體征多變,在疾病的早期快速識別成為挑戰(zhàn)。影響CVT診斷的因素多樣,包括年齡、危險(xiǎn)因素、臨床癥狀、血D-D水平和影像學(xué)表現(xiàn)等,由于各個(gè)研究納入病例嚴(yán)重程度不同以及診治水平的不同,導(dǎo)致研究結(jié)果各不相同。本研究采用單因素及多因素分析方法進(jìn)一步探討影響腦靜脈系統(tǒng)血栓形成(CVT)早期診斷的相關(guān)因素。方法:回顧性分析長海醫(yī)院自2008年9月至2016年8月收治符合條件的104例CVT患者的臨床資料,記錄臨床人口基線資料,現(xiàn)病史,既往史,實(shí)驗(yàn)室檢查結(jié)果、影像學(xué)資料及治療方法,出院前一天及隨訪時(shí)的mRS評分(Modified Rankin Scale,mRS)。根據(jù)發(fā)病到確診時(shí)間分為早期診斷組(≤7天)和延遲診斷組(7天)。比較兩組患者的基本臨床資料,采用單因素和多因素Logistic回歸分析影響疾病確診的危險(xiǎn)因素。結(jié)果:早期診斷組53例(51.0%),其中女性30例(56.6%),男性23例(43.4%);年齡18-64歲,平均年齡為34.13±13.78歲;延遲診斷組51例(49.0%),其中女性21例(41.2%),男性30例(58.8%);年齡18-75歲,平均年齡為42.57±15.07歲。單因素分析顯示,年齡45歲(P=0.043)、孕產(chǎn)期發(fā)病(P=0.029)、血D-D(P=0.003)、腦實(shí)質(zhì)損傷(P=0.000)、治療后復(fù)查靜脈再通(P=0.037)兩組間比較差異有統(tǒng)計(jì)學(xué)意義。多因素Logistic回歸分析顯示,年齡(OR=4.197,95%CI=1.378~12.785;P=0.012)、血D-D(OR=0.896,95%CI=0.809~0.992;P=0.034)、腦實(shí)質(zhì)損傷(OR=0.167,95%CI=0.052~0.540;P=0.003)是影響CVT早期診斷的獨(dú)立危險(xiǎn)因素。結(jié)論:年齡、血D-D水平、腦實(shí)質(zhì)損傷是影響CVT早期診斷的重要因素。早期診斷可提高靜脈再通率。第二部分側(cè)竇血栓形成的臨床特征分析目的:側(cè)竇血栓形成(Lateral Sinus Thrombosis,LST)占腦靜脈系統(tǒng)血栓形成(Cerebral venous thrombosis,CVT)的10%,因受對側(cè)側(cè)竇開放的代償其臨床癥狀缺乏典型性,成為誤診的重要原因。本研究將LST與其他部位血栓形成CVT患者的臨床癥狀、影像學(xué)表現(xiàn)及治療方式進(jìn)行比較,探討LST的臨床特點(diǎn)及影像學(xué)規(guī)律,為臨床診斷和治療提供指導(dǎo)。方法:回顧性連續(xù)收集2008年9月至2016年8月于長海醫(yī)院住院治療確診為CVT患者的住院病例資料,根據(jù)頭顱MRV或CTV或DSA,將病例分為LST和其他部位血栓形成對比組,比較分析LST的臨床特征。結(jié)果:104例CVT患者納入研究,其中女性51例(49.0%),男性53例(51.0%);年齡18-75歲,平均38.20±14.44歲。影像學(xué)結(jié)果顯示上矢狀竇受累51例(49.0%),側(cè)竇受累91例(87.5%),其中SSST7例(6.7%),LST33例(31.7%)。LST與其他部位血栓形成的臨床特征比較分析:LST33(31.7%)例,年齡18-75歲,平均41.85±16.00歲;其他部位血栓形成71例(68.3%),年齡18-68歲,平均36.56±13.34歲。兩組間年齡、性別及危險(xiǎn)因素均無統(tǒng)計(jì)學(xué)差異(P0.05)。在臨床癥狀方面,66.7%的LST患者僅表現(xiàn)為頭痛,明顯高于其他部位血栓形成的CVT患者(66.7%vs23.9%,P=0.001),但出現(xiàn)局灶性神經(jīng)功能缺失癥狀及癲癇相對少見(P1=0.003、P2=0.000),其中出現(xiàn)偏癱的患者比例同樣低于其他部位血栓形成的CVT患者(3.0%vs22.5%,P=0.011);LST的顱內(nèi)壓增高比例及腦脊液壓力平均值均低于其他部位血栓形成的CVT患者(P1=0.000、P2=0.000),而血D-D值及腦實(shí)質(zhì)損傷兩組間未見差異(P0.05);LST患者發(fā)病7天內(nèi)確診比例低于其他部位血栓形成(36.4%vs57.8%,P=0.042);在治療的選擇及近期神經(jīng)功能預(yù)后兩組間未見差異(P0.05)。LST與雙側(cè)側(cè)竇受累的患者相比,LST顱內(nèi)壓增高的比例、腦脊液壓力平均值較低(P1=0.013、P2=0.001),影像學(xué)檢查腦實(shí)質(zhì)損傷比例低(P=0.033)。結(jié)論:LST中有2/3的患者僅表現(xiàn)為頭痛,出現(xiàn)局灶性神經(jīng)功能缺失癥狀及癲癇相對少見。未受累靜脈竇的開放代償使得LST患者的顱內(nèi)壓升高程度相對較低。LST不易早期確診。
[Abstract]:The first part of the analysis of the related factors affecting the early diagnosis of cerebral venous thrombosis: due to the symptoms of CVT, the changes in the signs and the early rapid identification of the disease become a challenge. The factors affecting the diagnosis of CVT are varied, including age, risk factors, clinical symptoms, blood D-D level and imaging manifestations, due to the severity of the study. Different levels of gravity and different levels of diagnosis and treatment resulted in different results. This study used single factor and multi factor analysis to further explore the related factors affecting the early diagnosis of cerebral venous thrombosis (CVT). Methods: a retrospective analysis of 104 cases of CVT patients who were eligible from September 2008 to August 2016 in Changhai Hospital were analyzed retrospectively. The clinical data, the clinical population baseline data, the current history, the past history, the laboratory examination results, the imaging data and the treatment methods, the mRS score (Modified Rankin Scale, mRS) at the day before discharge and the follow-up period were divided into the early diagnosis group (less than 7 days) and the delayed diagnosis group (7 days). Comparison of the two groups of patients was compared. Clinical data, single factor and multiple factor Logistic regression analysis were used to analyze the risk factors of disease diagnosis. Results: early diagnosis group was 53 cases (51%), of which 30 cases (56.6%), male 23 (43.4%), age 18-64, average age of 34.13 + 13.78, 51 cases (49%) in delayed diagnosis group, among which female 21 (41.2%), male 30 cases; age The average age of -75 years was 42.57 + 15.07 years. Univariate analysis showed that age 45 (P=0.043), pregnancy and birth (P=0.029), blood D-D (P=0.003), brain parenchyma damage (P=0.000), and two groups of reexamination of vein repassage (P=0.037) after treatment were statistically significant. Multiple factor Logistic regression analysis showed that age (OR=4.197,95%CI=1.378~12.785; P=0.0) 12), blood D-D (OR=0.896,95%CI=0.809~0.992; P=0.034), cerebral parenchymal injury (OR=0.167,95%CI=0.052~0.540; P=0.003) is an independent risk factor for the early diagnosis of CVT. Conclusion: age, blood D-D level, brain parenchyma injury are important factors affecting the early diagnosis of CVT. Early diagnosis can improve the rate of venous recanalization. The second part of the side sinus thrombosis is the main factor. Lateral Sinus Thrombosis (LST) accounts for 10% of the cerebral venous thrombosis (Cerebral venous thrombosis, CVT). The clinical symptoms are not typical due to the opening of the side side of the lateral sinuses. The clinical features and imaging rules of LST were compared, and the clinical features and imaging rules were explored to provide guidance for clinical diagnosis and treatment. Methods: a retrospective collection of hospitalized cases of CVT patients admitted to Changhai Hospital from September 2008 to August 2016 was collected, according to the head MRV or CTV or DSA, the cases were divided into LST and other cases. The clinical features of LST were compared and analyzed. Results: 104 cases of CVT were included in the study, including 51 women (49%), 53 men (51%), 18-75 years old, with an average of 38.20 + 14.44 years. The imaging results showed that the upper sagittal sinus was involved in 51 cases (49%), and the lateral sinus was involved in 91 (87.5%), including SSST7 (6.7%) and.LST with LST33 (31.7%).LST with LST33 Comparative analysis of clinical characteristics of thrombosis in his site: LST33 (31.7%) cases, age 18-75 years, average 41.85 + 16 years, 71 cases of thrombosis in other sites (68.3%), age 18-68 years, average 36.56 + 13.34 years old. Two groups of age, sex and risk factors are not statistically different (P0.05). In clinical symptoms, 66.7% of LST patients only manifested headache. CVT patients (66.7%vs23.9%, P=0.001) were significantly higher than other sites of thrombosis (66.7%vs23.9%, P=0.001), but the symptoms of focal neurological deficit and epilepsy were relatively rare (P1=0.003, P2=0.000), and the proportion of patients with hemiplegia was also lower than that of other CVT patients (3.0%vs22.5%, P=0.011); the proportion of increased intracranial pressure and cerebrospinal fluid in LST. The average pressure of pressure was lower than that of CVT (P1=0.000, P2=0.000) in other parts of thrombus, but there was no difference between the two groups of blood D-D and brain parenchyma (P0.05). The proportion of diagnosis in LST patients was lower than that of other sites (36.4%vs57.8%, P=0.042) in 7 days (36.4%vs57.8%, P=0.042), and there was no difference between the two groups in the choice of treatment and the prognosis of the recent neurological function (P0.05). .LST was compared with the patients with bilateral sinus involvement, the ratio of LST intracranial pressure increased, the mean cerebrospinal fluid pressure was lower (P1=0.013, P2=0.001), and the proportion of cerebral parenchyma damage was low (P=0.033). Conclusion: the patients with 2/3 in LST showed only headache, the symptoms of focal deletions and epilepsy were relatively rare. Open compensation makes intracranial pressure elevation of LST patients relatively low..LST is not easy to diagnose early.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
本文編號：2147224
[Abstract]:The first part of the analysis of the related factors affecting the early diagnosis of cerebral venous thrombosis: due to the symptoms of CVT, the changes in the signs and the early rapid identification of the disease become a challenge. The factors affecting the diagnosis of CVT are varied, including age, risk factors, clinical symptoms, blood D-D level and imaging manifestations, due to the severity of the study. Different levels of gravity and different levels of diagnosis and treatment resulted in different results. This study used single factor and multi factor analysis to further explore the related factors affecting the early diagnosis of cerebral venous thrombosis (CVT). Methods: a retrospective analysis of 104 cases of CVT patients who were eligible from September 2008 to August 2016 in Changhai Hospital were analyzed retrospectively. The clinical data, the clinical population baseline data, the current history, the past history, the laboratory examination results, the imaging data and the treatment methods, the mRS score (Modified Rankin Scale, mRS) at the day before discharge and the follow-up period were divided into the early diagnosis group (less than 7 days) and the delayed diagnosis group (7 days). Comparison of the two groups of patients was compared. Clinical data, single factor and multiple factor Logistic regression analysis were used to analyze the risk factors of disease diagnosis. Results: early diagnosis group was 53 cases (51%), of which 30 cases (56.6%), male 23 (43.4%), age 18-64, average age of 34.13 + 13.78, 51 cases (49%) in delayed diagnosis group, among which female 21 (41.2%), male 30 cases; age The average age of -75 years was 42.57 + 15.07 years. Univariate analysis showed that age 45 (P=0.043), pregnancy and birth (P=0.029), blood D-D (P=0.003), brain parenchyma damage (P=0.000), and two groups of reexamination of vein repassage (P=0.037) after treatment were statistically significant. Multiple factor Logistic regression analysis showed that age (OR=4.197,95%CI=1.378~12.785; P=0.0) 12), blood D-D (OR=0.896,95%CI=0.809~0.992; P=0.034), cerebral parenchymal injury (OR=0.167,95%CI=0.052~0.540; P=0.003) is an independent risk factor for the early diagnosis of CVT. Conclusion: age, blood D-D level, brain parenchyma injury are important factors affecting the early diagnosis of CVT. Early diagnosis can improve the rate of venous recanalization. The second part of the side sinus thrombosis is the main factor. Lateral Sinus Thrombosis (LST) accounts for 10% of the cerebral venous thrombosis (Cerebral venous thrombosis, CVT). The clinical symptoms are not typical due to the opening of the side side of the lateral sinuses. The clinical features and imaging rules of LST were compared, and the clinical features and imaging rules were explored to provide guidance for clinical diagnosis and treatment. Methods: a retrospective collection of hospitalized cases of CVT patients admitted to Changhai Hospital from September 2008 to August 2016 was collected, according to the head MRV or CTV or DSA, the cases were divided into LST and other cases. The clinical features of LST were compared and analyzed. Results: 104 cases of CVT were included in the study, including 51 women (49%), 53 men (51%), 18-75 years old, with an average of 38.20 + 14.44 years. The imaging results showed that the upper sagittal sinus was involved in 51 cases (49%), and the lateral sinus was involved in 91 (87.5%), including SSST7 (6.7%) and.LST with LST33 (31.7%).LST with LST33 Comparative analysis of clinical characteristics of thrombosis in his site: LST33 (31.7%) cases, age 18-75 years, average 41.85 + 16 years, 71 cases of thrombosis in other sites (68.3%), age 18-68 years, average 36.56 + 13.34 years old. Two groups of age, sex and risk factors are not statistically different (P0.05). In clinical symptoms, 66.7% of LST patients only manifested headache. CVT patients (66.7%vs23.9%, P=0.001) were significantly higher than other sites of thrombosis (66.7%vs23.9%, P=0.001), but the symptoms of focal neurological deficit and epilepsy were relatively rare (P1=0.003, P2=0.000), and the proportion of patients with hemiplegia was also lower than that of other CVT patients (3.0%vs22.5%, P=0.011); the proportion of increased intracranial pressure and cerebrospinal fluid in LST. The average pressure of pressure was lower than that of CVT (P1=0.000, P2=0.000) in other parts of thrombus, but there was no difference between the two groups of blood D-D and brain parenchyma (P0.05). The proportion of diagnosis in LST patients was lower than that of other sites (36.4%vs57.8%, P=0.042) in 7 days (36.4%vs57.8%, P=0.042), and there was no difference between the two groups in the choice of treatment and the prognosis of the recent neurological function (P0.05). .LST was compared with the patients with bilateral sinus involvement, the ratio of LST intracranial pressure increased, the mean cerebrospinal fluid pressure was lower (P1=0.013, P2=0.001), and the proportion of cerebral parenchyma damage was low (P=0.033). Conclusion: the patients with 2/3 in LST showed only headache, the symptoms of focal deletions and epilepsy were relatively rare. Open compensation makes intracranial pressure elevation of LST patients relatively low..LST is not easy to diagnose early.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
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