Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
Neurol India. 2010 Jul-Aug;58(4):555-9. doi: 10.4103/0028-3886.68676.
The exact pathogenesis of pregnancy associated cerebral venous thrombois is still unsettled. Aims : To identify possible inherited and acquired prothrombotic risk factors and also identify the factors associated with mortality in pregnancy associated CVT.
Prospective cohort study to identify prothrombotic risk factors and case control study of influence of local traditional practice of puerperal water restriction on postpartum CVT.
Consecutive patients with pregnancy associated CVT seen over a period of three years. Thrombotic workup included genetic markers, protein assays, and other factors.
Univariate and chi-square analysis.
Of the 41 patients studied during the study period, 71% of patient had a single and 34% had multiple prothrombotic risk factors. Methylene tetrahydro-folate reductase (MTHFR) heterozygosity (19.5%) and factor V Leiden heterozygous (7.3%) were the commonest genetic markers. Hyperhomocysteinemia (34%) and elevated factor VIII levels (14.6%) were the other important risk factors. In this cohort the mortality was 17%. Mortality increased by odds of 1.3 for every additional prothrombotic marker. The factors associated with increased mortality included: status epileptics (P = 0.05, OR 13.2, 95% CI 1.002 - 173), deep venous system involvement (P = 0.016, OR 9.64, 95% CI 1.53 - 60.6), presence of midline shift (P = 0.012, OR 24.7, 95% CI 2.05 - 29.8) and diffuse cerebral edema (P = 0.006, OR 14.5, 95% CI 2.18- 96.4). The traditional practice of decrease intake of water during puerperium was significant in woman with pregnancy associated CVT when compared to control subjects (P < 0.02).
In patients with pregnancy associated CVT, prothrombotic markers can be multiple and are associated with increased odds of mortality. Deep venous system involvement, presence of midline shift and diffuse cerebral edema increased mortality. Peuperial water restriction may be a modifiable risk factor.
妊娠相关脑静脉血栓形成的确切发病机制仍未确定。目的：确定可能的遗传性和获得性血栓形成前危险因素，并确定与妊娠相关 CVT 死亡率相关的因素。
前瞻性队列研究，以确定血栓形成前危险因素，病例对照研究局部传统产褥期限水对产后 CVT 的影响。
连续观察三年期间患有妊娠相关 CVT 的患者。血栓形成工作包括遗传标记物、蛋白分析和其他因素。
单变量和卡方分析。
在研究期间，41 名患者中 71%的患者有单一和 34%的患者有多个血栓形成前危险因素。亚甲基四氢叶酸还原酶（MTHFR）杂合性（19.5%）和因子 V 莱顿杂合性（7.3%）是最常见的遗传标记物。高同型半胱氨酸血症（34%）和因子 VIII 水平升高（14.6%）是其他重要的危险因素。在这组患者中，死亡率为 17%。每增加一个血栓形成前标志物，死亡率增加 1.3 倍。与死亡率增加相关的因素包括：癫痫状态（P=0.05，OR 13.2，95%CI 1.002-173）、深静脉系统受累（P=0.016，OR 9.64，95%CI 1.53-60.6）、中线移位（P=0.012，OR 24.7，95%CI 2.05-29.8）和弥漫性脑水肿（P=0.006，OR 14.5，95%CI 2.18-96.4）。与对照组相比，妊娠相关 CVT 患者产后饮水减少的传统做法具有显著意义（P<0.02）。
在妊娠相关 CVT 患者中，血栓形成前标志物可能是多种，与死亡率增加的几率相关。深静脉系统受累、中线移位和弥漫性脑水肿增加死亡率。产褥期限水可能是一个可改变的危险因素。
