诊断时间延迟对颅内静脉窦血栓形成患者临床特征及预后相关性的影响  

Correlation of delayed diagnosis of cerebral venous sinus thrombosis with its clinical symptoms and prognosis

作　　者：李玉生[1] 胡挺[1] 刘晓昀[1] 段振晖 孙瑞[1] 朱武生[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)神经内科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2017年第6期615-618,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81671170);江苏省社会发展-临床前沿技术项目(BE2016748)

摘　　要：目的颅内静脉窦血栓形成(CVST)误诊率较高,而关于CVST诊断时间与患者临床特征及预后之间的相关性研究较少,文中旨在探讨CVST患者的临床特征与其诊断时间长短之间的关系,并分析延迟诊断对患者预后的影响。方法回顾性分析2004年3月至2016年8月南京军区南京总医院神经内科收治的94例CVST住院患者临床资料。根据四分位诊断时间将患者分为<5 d组、5~9 d组、10~16 d组、>16 d组,主要研究终点是患者出院后3个月的改良RANKIN量表(modified Rankin Scale scorem,mRS)评分≤1分,次要研究终点是患者出院后3个月的mRS评分≤2分。并分析CVST患者延迟诊断时间与临床特征之间的相互关系。结果 CVST延迟诊断时间与视乳头水肿、孤立性颅内高压综合征、癫痫、颅内病灶、GCS评分有关(P<0.05);视乳头水肿、孤立性颅内高压综合征、GCS评分14~15分需要更长的诊断时间;癫痫、存在脑出血或梗塞病灶所需诊断时间较短。实验室指标中,低清蛋白水平、低总蛋白水平、高凝血酶时间、及高C反应蛋白水平的患者所需诊断时间较短(P<0.05)。延迟诊断时间的长短与CVST患者的mRS评分没有相关性(P>0.05)。结论为避免延迟诊断可以以CVST患者入院时的症状及实验室指标为体征及标志物,为指导临床CVST的早期诊断提供新的参考。Objective Cerebral venous sinus thrombosis （CVST） is easily misdiagnosed for lack of specificity in its patho- genesis and clinical symptoms and characteristics. This study was to investigate the association of the clinical features of CVST with the time of diagnosis and the impact of diagnostic delay on the prognosis of the disease. Methods We retrospectively studied the clinical data about 94 cases of CVST treated in our hospital from March 2004 to August 2016. According to the interquartile-range time of diag- nosis, we divided the patients into four groups, 〈5 d, 5-9 d, 10-16 d, and 〉16 d, and analyzed the correlation between the time ofdiagnostic delay with the clinical characteristics of the patients. The primary and secondary endpoints were the modified Rankin Scale score （mRS） ≤ 1 and ≤2 respectively at 3 months after discharge. Results Papilledema, isolated intracranial hypertension syndrome, and Glasgow Coma Score of ld-15 were associated with a longer diag- nostic delay than seizure and hemorrhagic or infarction lesions （P〈 0.05）. A significantly higher rate of earlier diagnosis was found in pa- tients with lower levels of albumin and total protein, longer thrombintime, and a higher level of C-reaction protein （P〈0.05）. However, no significant correlation was observed between the time of diagnos- tie delay and the prognosis CVST. Conclusion The symptoms and laboratory indexes of the CVST patients at admission can be used as markers for the diagnosis of CVST, which may provide some new idea for its early diagnosis.

关 键 词：颅内静脉窦血栓形成 延迟诊断 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]