Girot Marie, Ferro José M, Canhão Patrícia, Stam Jan, Bousser Marie-Germaine, Barinagarrementeria Fernando, Leys Didier
Department of Neurology, Lille University Hospital, Lille, France.
Stroke. 2007 Feb;38(2):337-42. doi: 10.1161/01.STR.0000254579.16319.35. Epub 2007 Jan 4.
Although intracerebral hemorrhages are frequent in patients with cerebral venous thrombosis, and lead to worse outcome, predictors of outcome in cerebral venous thrombosis patients with intracerebral hemorrhages have never been evaluated in adequately powered studies.
This study was conducted as a part of the International Study on Cerebral Vein and Dural Sinus Thrombosis. We evaluated predictors of outcome in cerebral venous thrombosis patients who had an "early intracerebral hemorrhage," ie, intracerebral hemorrhages already present at time of diagnosis of cerebral venous thrombosis by a logistic regression analysis, with a modified Rankin scale 3 to 6 at month 6 as dependent variable. The same analysis was performed with "delayed intracerebral hemorrhages," ie, intracerebral hemorrhages that occurred after the diagnosis of cerebral venous thrombosis, as dependent variable.
Of 624 patients recruited in International Study on Cerebral Vein and Dural Sinus Thrombosis, 245 (39%) had an early intracerebral hemorrhage: at month 6, 51 (21%) of them had a modified Rankin Scale 3 to 6. Independent predictors of having modified Rankin scale 3 to 6 at month 6 were older age (adjusted odds ratio for 1-year increase in age, 1.05; 95% CI, 1.02 to 1.08); male gender (adjusted odds ratio, 3.25; 95% CI, 1.29 to 8.16); having a deep cerebral venous system thrombosis (adjusted odds ratio, 5.43; 95% CI, 1.67 to 17.61) or a right lateral sinus thrombosis (adjusted odds ratio, 2.56; 95% CI, 1.03 to 6.40); and having a motor deficit (adjusted odds ratio, 2.94; 95% CI, 1.21 to 7.10). Of the 36 patients who had a delayed intracerebral hemorrhage, those who had a modified Rankin scale 3 to 6 at month 6 were less likely to have received heparin at the acute stage, and more likely to have had early intracerebral hemorrhage.
Among patients with early intracerebral hemorrhage, those who were older, men, had a thrombosis of the deep cerebral venous system or of the right lateral sinus, and a motor deficit were at higher risk for death or dependency at month 6. This subgroup of patients with predictors of poor outcome can be the target for new therapeutic strategies.
尽管脑出血在脑静脉血栓形成患者中很常见，且会导致更差的预后，但在样本量充足的研究中，从未对合并脑出血的脑静脉血栓形成患者的预后预测因素进行过评估。
本研究是脑静脉和硬脑膜窦血栓形成国际研究的一部分。我们通过逻辑回归分析，以6个月时改良Rankin量表评分为3至6分作为因变量，评估了患有“早期脑出血”（即脑静脉血栓形成诊断时已存在的脑出血）的脑静脉血栓形成患者的预后预测因素。对“延迟性脑出血”（即脑静脉血栓形成诊断后发生的脑出血）作为因变量进行了同样的分析。
在脑静脉和硬脑膜窦血栓形成国际研究招募的624例患者中，245例（39%）有早期脑出血：6个月时，其中51例（21%）改良Rankin量表评分为3至6分。6个月时改良Rankin量表评分为3至6分的独立预测因素为年龄较大（年龄每增加1岁，调整后的优势比为1.05；95%可信区间为1.02至1.08）；男性（调整后的优势比为3.25；95%可信区间为1.29至8.16）；患有大脑深静脉系统血栓形成（调整后的优势比为5.43；95%可信区间为1.67至17.61）或右侧横窦血栓形成（调整后的优势比为2.56；95%可信区间为1.03至6.40）；以及有运动功能缺损（调整后的优势比为2.94；95%可信区间为1.21至7.10）。在36例发生延迟性脑出血的患者中，6个月时改良Rankin量表评分为3至6分的患者在急性期接受肝素治疗的可能性较小，且更可能有早期脑出血。
在早期脑出血患者中，年龄较大、男性、患有大脑深静脉系统或右侧横窦血栓形成以及有运动功能缺损的患者在6个月时死亡或依赖的风险较高。这一具有预后不良预测因素的患者亚组可成为新治疗策略的目标人群。
