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脑静脉血栓形成患者在抗凝治疗下的再通时间。

Time to recanalisation in patients with cerebral venous thrombosis under anticoagulation therapy.

机构信息

Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, México City, Mexico.

Neurology Department, Johns Hopkins Community Physicians, Bethesda, Maryland, USA.

出版信息

J Neurol Neurosurg Psychiatry. 2016 Mar;87(3):247-51. doi: 10.1136/jnnp-2014-310068. Epub 2015 Mar 23.

Abstract

BACKGROUND AND PURPOSE

Few studies have investigated the rates of recanalisation after cerebral venous thrombosis (CVT). Our objective was to investigate the recanalisation rate and to identify predictors of recanalisation in patients with CVT.

METHODS

We included 102 patients with confirmed first-ever, non-septic CVT. All patients received anticoagulation for 12 months or until complete recanalisation. To assess recanalisation, patients underwent MR venography every 3 months until partial or complete recanalisation or for 12 months after diagnosis. We conducted two parallel analyses of complete recanalisation versus partial and no recanalisation versus any recanalisation. As a secondary objective we explored the influence of recanalisation on outcome and recurrent events. We calculated the probability of recanalisation using Kaplan-Meier analysis and conducted multivariate analysis using a Cox model.

RESULTS

The mean age of patients was 33.5±11 years (80 (78.4%) women). Survival analysis indicated that 50% of the patients had any recanalisation (grades I, II and III) by 64 days and complete recanalisation (grade III) by 169 days. Adjusted Cox proportional model revealed that age <50 years (HR=11.5 95% CI=1.58 to 84.46, p=0.01) and isolated superior sagittal sinus thrombosis (HR=0.39, 95% CI=0.14 to 1.04, p=0.05) predict complete recanalisation, while age <50 years (HR=4.79; 95% CI=1.69 to 13.5, p=0.003) predicts any recanalisation. Patients with complete recanalisation had a greater chance of good functional outcome (HR=5.17; 95% CI=2.8 to 9.53, p<0.001).

CONCLUSIONS

We found that recanalisation occurs over time, until month 11. Complete recanalisation may influence functional outcome.

摘要

背景与目的

鲜有研究调查脑静脉血栓形成(CVT)后的再通率。我们的目的是调查 CVT 患者的再通率,并确定再通的预测因素。

方法

我们纳入了 102 例确诊的首次非感染性 CVT 患者。所有患者均接受抗凝治疗 12 个月或直至完全再通。为评估再通情况,患者在部分或完全再通或诊断后 12 个月内每 3 个月接受 1 次 MR 静脉造影。我们进行了完全再通与部分再通和无再通与任何再通的平行分析。作为次要目标,我们探讨了再通对结局和复发性事件的影响。我们使用 Kaplan-Meier 分析计算再通概率,并使用 Cox 模型进行多变量分析。

结果

患者的平均年龄为 33.5±11 岁(80 例[78.4%]为女性)。生存分析表明,50%的患者在 64 天时有任何再通(I、II 和 III 级),在 169 天时有完全再通(III 级)。调整后的 Cox 比例模型显示,年龄<50 岁(HR=11.5,95%CI=1.58 至 84.46,p=0.01)和孤立性上矢状窦血栓形成(HR=0.39,95%CI=0.14 至 1.04,p=0.05)预测完全再通,而年龄<50 岁(HR=4.79;95%CI=1.69 至 13.5,p=0.003)预测任何再通。完全再通的患者有更好的功能结局的机会更大(HR=5.17;95%CI=2.8 至 9.53,p<0.001)。

结论

我们发现再通随时间发生,直到第 11 个月。完全再通可能影响功能结局。

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