产褥期颅内静脉血栓形成的危险因素分析

Analysis of risk factors for cerebral venous thrombosis in the postpartum period

摘要

目的 分析产褥期颅内静脉血栓形成(CVT)患者病历资料,结合既往资料探讨影响产褥期发生CVT的相关危险因素。方法 选择2010年7月至2024年1月在西安交通大学第一附属医院诊断为CVT的8例产褥期患者为研究对象,收集并回顾性分析其一般资料、临床表现、实验室和影像学检查,以及治疗方法、预后情况。结果 8例患者平均年龄(26.5±4.6)岁,平均住院(19.1±5.9)天,均以头痛症状为首发症状.1例患者有妊娠期高血压病史;1例患者有半月前上呼吸道感染史;2例患者有甲亢病史.8例患者D-二聚体均升高;6例(87.5%)患者纤维蛋白原降解产物升高;3例(37.5%)患者纤维蛋白原升高;5例(62.5%)患者血红蛋白减少;6例患者检测同型半胱氨酸水平,其中5例(83.3%)升高.影像学检查结果显示,大脑皮层静脉血栓形成1例(12.5%),静脉窦血栓形成7例(87.5%),累及上矢状窦6例(75.0%),横窦5例(62.5%),乙状窦5例(62.5%),直窦2例(25.0%),其中累及2个静脉窦及以上者6例(75.0%).8例患者均进行了低分子肝素抗凝治疗、脱水降颅压治疗.8例患者中,6例(75.0%)预后良好。结论 凝血遗传因子异常、感染、高同型半胱氨酸及其他合并症如甲亢、高血压等均为产褥期CVT的危险因素.

Abstract

Objective To analyze the clinical data of patients with postpartum cerebral venous thrombosis (CVT) and to explore the related risk factors for CVT during the puerperium based on current and previous evidence. Methods A total of 8 puerperal patients diagnosed with CVT in the First Affiliated Hospital of Xi′an Jiaotong University from July 2010 to January 2024 were included. General clinical information, clinical manifestations, laboratory and imaging findings, treatment strategies, and prognosis were collected and retrospectively analyzed. Results The mean age of the 8 patients was (26.5±4.6) years, and the average hospital stay was (19.1±5.9) days. All patients presented with headache as the initial symptom. One patient had a history of gestational hypertension, one had an upper respiratory tract infection two weeks prior and two had a history of hyperthyroidism. All 8 patients showed elevated D-dimer levels; fibrin degradation products were increased in 6 patients (87.5%); fibrinogen was elevated in 3 patients (37.5%); hemoglobin levels were reduced in 5 patients (62.5%). Homocysteine levels were tested in 6 patients, among whom 5 (83.3%) were elevated. Imaging examinations revealed cortical venous thrombosis in 1 case (12.5%) and venous sinus thrombosis in 7 cases (87.5%), involving the superior sagittal sinus in 6 cases (75.0%), transverse sinus in 5 cases (62.5%), sigmoid sinus in 5 cases (62.5%), and straight sinus in 2 cases (25.0%). Six cases (75.0%) involved ≥2 venous sinuses. All patients received low-molecular-weight heparin anticoagulation and dehydration therapy to reduce intracranial pressure. Among the 8 patients, 6 (75.0%) had a favorable prognosis. Conclusion Genetic coagulation abnormalities, infections, elevated homocysteine, and comorbidities such as hyperthyroidism and hypertension are important risk factors for postpartum CVT.

关键词

产褥期 / 颅内静脉血栓 / 危险因素 / 预后

Key words

puerperium / cerebral venous thrombosis / risk factor / prognosis

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