脑静脉窦血栓形成患者早期癫痫发作与血清D-二聚体相关性的研究

Correlation between early seizures in patients with cerebral venous sinus thrombosis and serum D-dimer level

摘要:

目的 探讨脑静脉窦血栓形成（cerebral venous sinus thrombosis，CVST）患者早期癫痫发作与血清D-二聚体水平的相关性及对预后的影响。方法 回顾2010年11月至2021年3月在海军军医大学第一附属医院神经内科及脑血管病中心住院的CVST患者，收集患者一般情况、CVST诊疗情况及相关血液学指标等资料。根据患者有无早期癫痫发作将其分为2组，对2组间指标进行差异分析，并通过logistic回归分析研究早期癫痫发作的影响因素；通过改良Rankin量表（modified Rankin scale，mRS）评分将患者分为预后良好组及预后不良组，分析血清D-二聚体水平与CVST患者预后的关系。结果 共纳入CVST患者60例，其中有癫痫发作组22例（36.7%），无癫痫发作组38例。比较2组患者基线资料及血液学指标情况发现，有癫痫发作组mRS评分和D-二聚体水平明显高于无癫痫发作组；logistic回归分析结果显示血清D-二聚体水平是CVST早期癫痫发作的危险因素（OR=1.513，95%CI=1.022～2.241，P=0.039）；早期癫痫发作与CVST患者预后不良相关，而治疗前后血清D-二聚体水平及其下降幅度均与疾病预后无明显相关。结论 血清高D-二聚体水平和CVST患者早期癫痫发作有关，早期癫痫发作影响CVST患者预后，因此对入院时血清D-二聚体升高的CVST患者应尽早干预，有望预防早期癫痫发作来改善患者预后。

Abstract:

Objective To investigate the relationship between early seizures in patients with cerebral venous sinus thrombosis（CVST）and the serum D-dimer level，and discuss the effects on the prognosis.Methods The CVST patients who were treated in the wards of Neurological and Cerebrovascular Departments of The First Affiliated Hospital of Naval Medical University from November 2010 to March 2021 were reviewed，and the general information，diagnosis and treatment of CVST and related hematological indicators of the patients were collected. Then the patients were divided into two groups according to the presence or absence of early seizures，the differences of related indicators between the two groups were analyzed，and the influencing factors of early seizures were studied by logistic regression analysis. The patients were divided into good and poor prognosis group by modified Rankin scale（mRS） score，and the relationship between serum D-dimer level and prognosis of CVST patients was analyzed.Results A total of 60 patients with CVST were included，including 22（36.7%） with seizure and 38 without seizure. The results of comparing the baseline data and hematological indexes of the two groups showed that mRS score and D-dimer level in the seizure group were significantly higher than those in the non-seizure group，and the incidence of poor prognosis was significantly higher than that of the non-seizure group； logistic regression analysis showed that D-dimer level might be a risk factor for early seizures in CVST（OR=1.513，95%CI=1.022-2.241，P=0.039）；early seizures were related to the poor prognosis of CVST patients，and serum D-dimer level before and after treatment and its decreasing range were not significantly related to disease prognosis.Conclusion High serum D-dimer levels are associated with early seizures in CVST，and early seizures affect the prognosis of CVST patients. Therefore，early intervention in CVST patients with elevated serum D-dimer on admission is expected to prevent early seizures and improve outcomes of CVST patients.