抗磷脂综合征合并脑静脉窦血栓形成12例分析  

Clinical characteristics of 12 patients with cerebral venous sinus thrombosis in antiphospholipid syndrome

作　　者：申慧鑫 樊春秋[1] 黄小钦[1] Shen Huixin;Fan Chunqiu;Huang Xiaoqin(Neurology Department,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《神经疾病与精神卫生》2019年第9期883-888,共6页Journal of Neuroscience and Mental Health

基　　金：国家重点研发计划项目(2016YFC1300600,2016YFC0901004)。

摘　　要：目的探讨抗磷脂综合征(APS)合并脑静脉窦血栓形成(CVST)的临床特点,以提高诊疗水平。方法回顾性分析首都医科大学宣武医院2012年1月至2019年4月收住院的APS合并CVST患者的临床特点、实验室检查、影像学结果、治疗以及转归,并与非CVST的APS患者进行比较。结果共纳入APS合并CVST患者12例,其中女10例,男2例;年龄(35.25±4.61)岁冲位病程为1.9(0.6,6.0)个月。急性起病7例,亚急性起病2例.慢性起病3例。主要临床表现:头痛12例,颅内压升高10例,视力下降或视觉障碍7例,视盘水肿7例,复视或眼球运动障碍4例,恶心呕吐4例。磁共振静脉血管成像(MRV)显示静脉受累情况为:乙状窦8例、颈内静脉7例、横窦6例以及上矢状窦5例。APS合并CVST患者的血小板降低发生率⑸⑵高于非CVST的APS患者(11.1%,4/36),差异有统计学意义(P=0.032)。所有患者均接受抗凝治疗,其中部分接受抗血小板、血管内再通治疗、脱水降颅压以及激素治疗。12例患者出院时病情均有改善,出院后随访6-28个月期间所有患者均无复发。结论APS患者需要警惕CVST的可能性。当APS患者出现颅高压症状时,应尽早完善头颅MRV等影像学检查评估是否存在CVST,以早诊断、早治疗,从而改善患者预后。Objective To explore the clinical characteristics of cerebral venous sinus thrombosis(CVST)in patients with antiphospholipid syndrome(APS),so as to improve the diagnosis and treatment level.Methods The clinical characteristics,laboratory examination,imaging results,treatment and outcome of APS patients with CVST admitted to Xuanwu Hospital,Capital Medical University from January 2012 to April 2019 were analyzed retrospectively,and compared with APS patients without CVST.Results A total of 12 patients with APS and CVST were recruited,including 10 female and 2 male patients.The average age was(35.25±4.61)years old,and median disease duration was 1.9(0.6,6.0)months.7 with acute onset,2 subacute onset,and 3 chronic onset.The main clinical manifestations were headache in 12 cases,increased intracranial pressure in 10 cases,visual impairment in 7 cases,papilledema in 7 cases,diplopia or eye movement disorder in 4 cases,nausea and vomiting in 4 cases.MR venography(MRV)showed venous involvement in 8 cases of sigmoid sinus,7 cases of internal jugular vein,6 cases of transverse sinus and 5 cases of superior sagittal sinus.The incidence of thrombocytopenia in APS patients with CVST(5/12)was significantly higher than that in non CVST patients(11.1%,4/36),and the difference was statistically significant(P=0.032).All patients received anticoagulant therapy,some of them received antiplatelet,intravascular recanalization,dehydration,intracranial pressure reduction and hormone therapy.All the 12 patients improved at the time of discharge,and there was no recurrence during the follow-up period of 6-28 months.Conclusions APS patients need to be aware of the possibility of CVST.When the patients with APS have symptoms of intracranial hypertension,it is suggested to improve the imaging examination such as MRV of the head as soon as possible to evaluate whether there is CVST,so as to make early diagnosis and treatment for better prognosis.

关 键 词：抗磷脂综合征 脑静脉窦血栓形成 磁共振静脉血管成像 抗凝 

分 类 号：R74[医药卫生—神经病学与精神病学]