自发性硬脑膜动静脉瘘诊断延误的相关因素及对预后的影响  

Delay in Diagnosis of Spontaneous Dual Arteriovenous Fistulas:Correlative Factors and Influence on Outcome

作　　者：尚文锦[1] 陈红兵[1] 束礼明 唐舒锦 洪华[1] 

机构地区：[1]中山大学附属第一医院神经科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2017年第3期427-432,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技局计划项目(2014Y2-00502)

摘　　要：【目的】探讨自发性硬脑膜动静脉瘘(DAVF)诊断延误的相关因素及对预后的可能影响。【方法】连续纳入102例在中山大学附属第一医院确诊为自发性DAVF患者。分析了诊断延误的相关因素及对治疗和预后的影响。预后为出院时症状是否痊愈、改善或无改善。【结果】从发病到确诊DAVF的中位时间为3个月(四分位数间距:1~6个月)。与诊断较早组(诊断时间≤3个月)相比,诊断较晚组(诊断时间>3个月)头痛(P=0.012)、眼睑下垂(P=0.035)和颅内病灶(P=0.001)比例更低,结膜充血(P=0.004)、耳鸣(P=0.021)、视力障碍(P<0.001)、孤立视力障碍(P=0.007)和较晚完成影像学检查(P<0.001)比例更高,手术切除或夹闭病灶比例更低、血管内治疗比例更高(P=0.005),出院时症状已痊愈或改善比例更低(P=0.033),其中有视力障碍者痊愈或改善的比例较无视力障碍者更低(P=0.023)。与伴随其他症状的视力障碍者相比,孤立视力障碍患者以发作性黑朦或视朦起病(P<0.001)、双眼受累(P<0.001)和严重视力下降(P=0.057)比例更高,均有颅内高压[中位数(四分位数间距):405(370-512)mmH_2O],更多引流至横窦-乙状窦(P<0.001)而非海绵窦(P<0.001),但出院时痊愈或改善比例无差别(P=0.739)。【结论】诊断延误在自发性DAVF中是值得注意的,它会影响症状的改善,尤其是伴有视力障碍的患者。[Objective] To study the factors relative to the delayed diagnosis of spontaneous dual arteriovenous fistulas （DAVF） and its influence on the prognosis. [ Methods ] We included 102 continuous patients diagnosed DAVF in the First Affiliated Hospital of Sun Yat-sen University, and analyzed the correlative factors and impact on outcome of diagnostic delay. Outcome was whether symptoms were non-improvement, improvement or restoration at discharge. [Results ] Median delay from onset to diagnosis was 3 months （ interquartile range, 1 to 6 ）. Compared with patients diagnosed earlier （ diagnose time ≤3 months ）, patients diagnosed later （diagnose time 〉 3 months） had a lower frequency of headache （P = 0.012）, ptosis （P = 0.035） and parenchymal lesions （P = 0.001 ）, a higher frequency of conjunctival congestion （P =0.004）, tinnitus （P = 0.021 ）, visual dysfunction （P 〈 0.001 ）, isolated visual dysfunction （P = 0.007） and delayed imaging scan （P 〈 0.001 ）, a higher frequency of endovascular treatment, and a lower frequency of improvement or restoration at discharge （P =0.033） , in which patients with visual dysfunction had a lower frequency of improvement or restoration than those without visual dysfunction （P = 0.023）. Compared to those with visual dysfunction and other symptoms, patients with isolated visual dysfunction had a higher frequency of onset with paroxysmal blurring or blinding （P 〈 0.001 ）, two eyes involved （P 〈 0.001 ） and more severe visual loss （P = 0.057）, a higher frequency of draining into transverse- sigmoid sinus （P 〈 0.001 ） instead of cavernous sinus （P 〈 0.001 ） , and suffered intracranial hypertension all （median intracranial pressure, 405 mmH2O; interquartile range, 370 - 512 mmH2O）. However, no statistically significant differences were found in the frequency of improvement or restoration at discharge between two groups （P = 0.739）. [Conclusion ] Diagnostic delay was considerable in this cohort a

关 键 词：自发性硬脑膜动静脉瘘 视力障碍 诊断 预后 

分 类 号：R743.4[医药卫生—神经病学与精神病学]