孕产期颅内静脉窦血栓形成的临床特点  

Clinical features of cerebral venous sinus thrombosis in pregnancy or puerperium

作　　者：李敬伟[1] 王中原[1] 卢正娟[1] 罗云[1] 周建军[2] 庞伟[3] 徐运[1] 

机构地区：[1]南京大学医学院附属鼓楼医院神经内科,210008 [2]南京大学医学院附属鼓楼医院妇产科,210008 [3]南京鼓楼医院集团宿迁市人民医院神经内科

出　　处：《临床神经病学杂志》2013年第5期375-377,共3页Journal of Clinical Neurology

基　　金：国家自然科学青年基金项目(81200896);江苏省卫生厅青年科研项目(Q201206)

摘　　要：目的探讨孕产期颅内静脉窦血栓形成(CVST)的临床特点。方法回顾性分析12例孕产期CVST患者(孕产期CVST组)的临床资料,并与34例非孕产期CVST患者(非孕产期CVST组)进行比较。结果与非孕产期CVST组比较,孕产期CVST组年龄明显较小、病程明显缩短(均P<0.05)。孕产期CVST组患者主要临床表现为头痛,痫性发作,神经系统异常体征。孕产期CVST组痫性发作及神经系统异常体征的比例(41.7%,75.0%)均显著高于非孕产期CVST组(5.9%,41.2%)(均P<0.05)。孕产期CVST组患者D-二聚体阳性6例;头颅CT异常5例;头颅MRI异常10例。孕产期CVST组头颅MRI检出率(83.3%)明显高于非孕产期CVST组(50.0%)(P<0.05)。孕产期CVST组对比剂增强MR静脉成像(CE-MRV)检查发现闭塞的静脉窦12例,阳性率为100%。结论孕产期CVST患者病程短,发病急,易出现癫痫和脑实质损害;D-二聚体阴性不能排除CVST诊断,头颅MRI结合CE-MRV有助于早期确诊。Objective To investigate the clinical features of cerebral venous sinus thrombosis （CVST） in pregnancy or puerperium. Methods The clinical datas of 12 CVST patients in pregnancy or puerperium stege （ P- CVST group ） were analyzed retrospectively and compared with 34 CVST patients who were not in pregnancy or puerperium stage （non P-CVST group）. Results Compared with non P-CVST group, the patients in P-CVST group were younger and their courses of disease were shorter （ all P 〈 0. 05 ）. The chief clinical manifestations in P-CVST group were headache, seizure and abnormal signs of nervous system. The proportion of seizure and abnormal signs of nervous system in P-CVST group （ 41.7%, 75.0% ） were significantly higher than that in non P-CVST group （5.9%, 41.2% ） （all P 〈0. 05）. There were 6 cases with positive D-dimer, 5 cases with CT abnormal and 10 cases with MRI abnormal in P-CVST group. The relevance ratio of MRI in P-CVST group （83.3%） was significantly higher than that in non P-CVST group （50.0%） （P 〈 0. 05 ）. Contrast-enhanced MR venography （CE-MRV） found 12 cases with occlusive sinus in P-CVST group, the positive rate was 100%. Conclusions CVST patients during pregnancy or puerperium have short courses of disease and acute onset, and they are liable to appear seizure or brain parenchymal damage. Negative D-dimer can not rule out the possibility of CVST. Cranial MRI scan combined with CE-MRV can help to diagnose in a timely manner.

关 键 词：妊娠期 产褥期 颅内静脉窦血栓形成 临床特点 

分 类 号：R714.2[医药卫生—妇产科学]