儿童颅内静脉窦血栓形成的临床特点及抗凝疗效  

Clinical characteristics and anticoagulation effects of cerebral venous sinus thrombosis in children

作　　者：张献礼 邱德智 何俊平[1] 高喆 郑雷[1] 颜青 王刚[1] Zhang Xianli;Qiu Dezhi;He Junping;Gao Zhe;Zheng Lei;Yan Qing;Wang Gang(Department of Neurosurgery,Children′s Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院神经外科,南京210000

出　　处：《中华神经外科杂志》2023年第10期1015-1019,共5页Chinese Journal of Neurosurgery

摘　　要：目的 分析儿童颅内静脉窦血栓形成(CVST)的临床特点、病因和预后.方法 2019年3月至2022年12月南京医科大学附属儿童医院神经外科收治20例CVST患儿,所有患儿确诊后立即给予低分子肝素皮下注射,1 000 IU/10kg,2次/d,共15 d;第12~15天同时口服华法林,根据国际标准化比值(维持在2~3)调节药物剂量,之后根据病因不同个体化应用华法林.回顾性分析患儿的临床症状、病因、影像学特点、实验室指标及抗凝疗效.结果 20例患儿起病至就诊的中位时间为5.5 d(0.5~17.0 d);发病以头痛为主的14例、发热4例、癫痫1例、偏瘫1例,治疗前改良Rankin量表评分(mRS)1分17例,3分1例,4分2例.病变位于横窦、乙状窦15例,上矢状窦5例(3例累及皮质静脉).13例患儿的致病因素为中耳乳突炎,病变均位于横窦、乙状窦.7例为非感染性因素,其中2例为白血病,溃疡性结肠炎、TBHB基因突变、颅脑外伤、系统性红斑狼疮各1例,病因不明1例;5例病变位于上矢状窦,其中3例合并脑水肿和出血转化.治疗前D-二聚体≥500 ng/ml的有8例.20例患儿的中位随访时间为12.5个月(6~51个月).因系统性红斑狼疮脑病、多器官功能衰竭死亡1例;至末次随访mRS 0分18例,2分1例;治疗后3个月头颅MR静脉造影显示静脉窦血栓受累位置均再通,6个月随访显示均无复发.结论 儿童CVST的病因复杂,中耳乳突炎是最常见的危险因素,主要病变部位在横窦、乙状窦.积极的抗凝治疗是安全有效的,大部分患儿预后较好.Objective To analyze the clinical characteristics,etiologies and outcomes of cerebral venous sinus thrombosis(CVST)in children.Methods A total of 20 children with CVST were admitted to the Department of Neurosurgery,Children′s Hospital of Nanjing Medical University from March 2019 to December 2022.All patients were given subcutaneous injection of low-molecular-weight heparin after diagnosis(1000 IU/10 kg,2 times/d)for a total of 15 days,warfarin was simultaneously administered on days 12-15,the drug dosage was adjusted according to the international standardized ratio(maintained at 2-3),and the medication time of warfarin was based on different etiologies.We retrospectively analyzed the clinical manifestations,etiologies,radiologic imaging,laboratory data,treatment and anticoagulant efficacy.Results The median time from onset to treatment in 20 children was 5.5 d(0.5-17.0 d).Among the patients,headache was reported as the main clinical manifestation in 14 cases,fever in 4 cases,epileptic seizure in 1 case and hemiplegia in 1 case.Modified Rankin scale score(mRS)before treatment was 1 point in 17 cases,3 points in 1 case,4 points in 2 cases.In this series,the lesion was located in the transverse-sigmoid sinus in 15 cases,in the superior sagittal sinus in 5 cases including 3 with involvement of cortical veins.The etiological factor of 13 children was otomastoiditis and their lesions were all located in the transverse-sigmoid sinus.Non-infectious etiological factors were reported in 7 cases including 2 cases of leukemia,1 case of ulcerative colitis,1 case of TBHB gene mutation,1 case of traumatic brain injury,1 case of systemic lupus erythematosus and 1 case with unknown etiology.In 5 cases,the lesions were located in the superior sagittal sinus,of which 3 cases were complicated with cerebral edema and bleeding transformation.Out of 20 children,8 reported the level of D-dimer≥500 ng/ml before treatment.The median follow-up time of 20 children was 12.5 months(6-51 months).One case died due to systemic lupus eryth

关 键 词：窦血栓形成 颅内 儿童 疾病特征 抗凝药 治疗结果 

分 类 号：R726.5[医药卫生—儿科]