脑静脉窦血栓形成并发痫性发作的危险因素和对临床转归的影响  

Epileptic seizures in acute cerebral venous sinus thrombosis： risk factors and effect on outcome

作　　者：沙杜鹃[1] 马浩[2] 顾双双[1] 王路娜[1] 钱健[2] 陈一冰[2] 张均[1] 

机构地区：[1]南京大学医学院附属鼓楼医院急诊科,210008 [2]南京医科大学鼓楼临床医学院急诊科,210008

出　　处：《国际脑血管病杂志》2015年第6期449-452,共4页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨脑静脉窦血栓形成（cerebral venous sinus thrombosis，CVST）患者继发痴性发作的危险因素及其对临床转归的影响。方法回顾性纳入CVST患者，收集危险因素、临床表现及影像学资料，对痢性发作组与非痫性发作组的资料进行比较。结果共纳入69例CVST患者，其中32例（46．38％）继发病性发作。在临床表现方面，痫性发作组患者更多表现为偏瘫（37．50％对15．63％；X^2=5．240，P=0．020）。影像学检查显示，痫性发作组更多表现为出血（29．41％对10．81％;X^2=3．818，P=0．047），损伤部位更多累及额叶（31．25％对10．81％；X^2=5．008，P=0．023）和颞叶（43．75％对8．11％;X^2=7．318，P=0．005），而且血栓形成部位多见于上矢状窦（65．63％对40．54％；X^2=4．264，P=0．036）。多变量logistic回归分析显示，局灶神经功能缺损（优势比5．167，95％可信区间1．993～15．764；P=0．004）和上矢状窦血栓形成（优势比0．126，95％可信区间0．042～0．370；P=0．039）是CVST患者继发痫性发作的独立危险因素。痫性发作组的院内病死率（6．25％对2．7％：／=0．512，P=0．469）和90d转归良好率（转归良好定义为Barthel指数〉60分）（81．25％对86．47％;X^2=0．346，P=0．793）与非痂性发作组无统计学差异。结论存在局灶神经功能缺损和上矢状窦血栓形成是CVST患者继发痫性发作的独立危险因素，但是否继发痫性发作与CVST患者的院内死亡风险和90d临床转归无关。Objective To investigate the risk factors of epileptic seizttres and its effect on clinical outcome in patients with cerebral venous sinus thrombosis （CVST）. Methods The patients with CVST were enrolled retrospectively. The risk factors, clinical manifestations, and imaging data were collected. The data of an epileptic seizure group and a non-epileptic seizure group were compared. Results A total of 69 patients with CVST were enrolled, including 32 （46. 38% ） secondary epileptic seizures. In the aspect of clinical manifestations, more patients showed hemiplegia in the epileptic seizure group （37.50% vs. 15.63% ;X^2 = 5. 240, P =0. 020）. Imaging examination showed that more patients in the epileptic seizure group presented with bleeding （29.41% vs. 10.81%; X^2= 3.818, P= 0.047）, more lesion involving frontal lobe （31.25% vs. 10. 81% ;X^2 =5. 008, P =0. 023）, and temporal lobe （43.75% vs. 8. 11%;X^2 =7. 318, P = 0. 005）, and the thrombosis sites were more common in the superior sagittal sinuses （65.63% vs. 40. 54% ; X^2 = 4. 264, P = 0. 036）. Multivariate logistic regression analysis showed that focal neurological deficits （odds ratio 5.167, 95% confidence interval 1. 993 - 15.764; P = 0. 004） and superior sagittal sinus thrombosis （odds ratio 0. 126, 95% confidence interval 0. 042 - 0. 370; P = 0. 039） were the independent risk factors for patients with secondary epileptic seizures. There were no significant differences in hospital mortality （6. 25% vs. 2. 7%;X^2= 0. 512, P= 0. 469） and 90 day 90-day full recovery rate （defined as Barthel Index 〉60） （81.25% vs. 86.47%;X^2 =0. 346, P=0. 793） between the epileptic seizure group and the non-epileptic seizure group. Conclusions Focal neurologic deficits and superior sagittal sinus thrombosis are the independent risk factors for secondary epileptic seizures, however, secondary epileptic seizures is not associated with in-hospital mortality risk and 90-day clinical outcomes in patients with CVST.

关 键 词：窦血栓形成 颅内 癫痫 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]