CAJ | 학술논문

目的探讨单发和多发脑静脉血栓形成(CVT)患者的临床特征和短期预后. 方法总结分析136例CVT患者的血栓部位及受累静脉窦/静脉数目,依受累颅内静脉窦/静脉数目将患者分为单发CVT组和多发CVT组,采用单变量分析比较2组患者的临床特点及预后. 结果单发CVT组44例,多发CVT组92例(其中累及2个部位45例,3个部位35例,4个部位9例,5个部位3例).最常受累的静脉窦/静脉为横窦/乙状窦(86.8%),其后依次为上矢状窦(58.1%)、直窦(18.4%)、大脑深静脉系统(7.4%)和皮层静脉系统(2.9%).单变量分析显示单发CVT组患者平均发病年龄大于多发CVT组,但短期预后好于多发CVT组,比较差异有统计学意义(P＜0.05);多发CVT组患者出现颅内实质病变及合并颅外静脉血栓的几率高于单发CVT组,同时治疗前颅内压≥300mm H2O的患者比例高于单发CVT组,比较差异有统计学意义(P＜0.05). 结论 CVT中以多发CVT所占比例较高,最容易受累的部位为横窦/乙状窦和上矢状窦.与单发CVT相比,多发CVT患者颅内压较高,多合并颅外静脉血栓,出现静脉性脑梗死和脑出血的几率较高,临床病情重,预后相对较差.
목적 탐토단발화다발뇌정맥혈전형성(CVT)환자적림상특정화단기예후. 방법 총결분석136례CVT환자적혈전부위급수루정맥두/정맥수목,의수루로내정맥두/정맥수목장환자분위단발CVT조화다발CVT조,채용단변량분석비교2조환자적림상특점급예후. 결과 단발CVT조44례,다발CVT조92례(기중루급2개부위45례,3개부위35례,4개부위9례,5개부위3례).최상수루적정맥두/정맥위횡두/을상두(86.8%),기후의차위상시상두(58.1%)、직두(18.4%)、대뇌심정맥계통(7.4%)화피층정맥계통(2.9%).단변량분석현시단발CVT조환자평균발병년령대우다발CVT조,단단기예후호우다발CVT조,비교차이유통계학의의(P＜0.05);다발CVT조환자출현로내실질병변급합병로외정맥혈전적궤솔고우단발CVT조,동시치료전로내압≥300mm H2O적환자비례고우단발CVT조,비교차이유통계학의의(P＜0.05). 결론 CVT중이다발CVT소점비례교고,최용역수루적부위위횡두/을상두화상시상두.여단발CVT상비,다발CVT환자로내압교고,다합병로외정맥혈전,출현정맥성뇌경사화뇌출혈적궤솔교고,림상병정중,예후상대교차.
Objective To discuss the different clinical features and prognosis of single cerebral venous thrombosis (CVT) and multiple CVT. Methods The site and the number of vein and thrombosed sinuses of 136 patients with CVT were summarized. The patients were divided into 2 groups according to the numbers of thrombosed sinuses. The clinical features and outcome of the patients with single CVT were analyzed in comparison with those with multiple CVT by univariate analysis. Results In 44 patients (32.4%), only 1 cerebral sinus was involved. In 92 patients (67.6%), 2 or more cerebral veins and sinuses were involved (2 sinuses in 45, 3 sinuses in 35, 4 sinuses in 9, 5 sinuses in 3). The lateral sinus and the sigmoid sinus were the most frequent thrombosed sinuses which were found in 86.8% of patients; the followings were superior sagittal sinus (58.1%), straight sinus (18.4%) , deep venous system (7.4%), and cortical veins (2.9%). Mean ages were significantly older but the short-term prognosis was better in the group of patients with single CVT in comparison with those in the group of patients with multiple CVT. The patients with multiple CVT also presented more serious intracranial hypertension, more frequent parenchymal lesions and systematic thrombotic events than those with single CVT (P＜0.05). Conclusion In most CVT patients, 2 or more veins and sinuses are involved and thromboses most commonly implicate the lateral sinus and the superior sagittal sinus. Patients with multiple CVT usually present higher intracranial pressure, more serious clinical course, worse outcome and higher incidence of systematic venous thrombotic events in comparison with patients with single CVT. And the multiple sinus thrombosis is more likely to cause venous infarctions and intracranial hemorrhage than the single one.