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抗磷脂综合征合并脑静脉窦血栓形成12例分析
申慧鑫樊春秋黄小钦
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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,中位病程为 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(5/12)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。
基金项目:国家重点研发计划项目(2016YFC1300600,2016YFC0901004)
Clinical characteristics of 12 patients with cerebral venous sinus thrombosis in antiphospholipid syndrome
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Abstract:
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.

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