Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
CNS Neurosci Ther. 2021 Nov;27(11):1396-1408. doi: 10.1111/cns.13719. Epub 2021 Aug 16.
To explore the effect of nonthrombotic internal jugular venous stenosis (IJVS) exerted on cerebral venous thrombosis (CVT).
Patients with imaging confirmed CVT were enrolled into this real-world case-control study consecutively from January 2018 through April 2021, and were divided into CVT and IJVS-CVT groups, according to whether or not with non-thrombotic IJVS. Chi-square and logistic regression models were utilized for between-group comparison of thrombotic factors.
A total of 199 eligible patients entered into final analysis, including 92 cases of CVT and 107 cases of IJVS-CVT. Chi-square revealed that thrombophilic conditions were found in majority of CVT, while only minority in the IJVS-CVT group (83.7% vs. 20.6%, p < 0.001). Multivariate logistic regression indicated that most identified thrombophilia were negatively related to IJVS-CVT (all p < 0.05), including oral contraceptive use (β = -1.38), hyperhomocysteinemia (β = -1.58), hematology (β = -2.05), protein C/S deficiency (β = -2.28), connective tissue disease (β = -1.18) and infection (β = -2.77). All recruited patients underwent standard anticoagulation, 10 cases in IJVS-CVT group also received jugular angioplasty for IJVS correction. Most participants obtained alleviations during 1-year follow-up. However, both clinical and imaging outcomes in IJVS-CVT group were not as good as those in CVT group (both p < 0.05). Moreover, 8 cases with CVT and 7 cases with IJVS-CVT were rehospitalized for CVT recurrences and underwent customized treatment.
Nonthrombotic IJVS may be one of the risk factors of CVT. Anticoagulation might need to be suggested for IJVS patients.
探讨非血栓性颈内静脉狭窄(IJVS)对脑静脉血栓形成(CVT)的影响。
本研究采用真实世界病例对照研究设计,连续纳入 2018 年 1 月至 2021 年 4 月期间经影像学证实的 CVT 患者,根据是否存在非血栓性 IJVS 将患者分为 CVT 组和 IJVS-CVT 组。采用卡方检验和逻辑回归模型比较两组的血栓形成因素。
共纳入 199 例符合条件的患者进行最终分析,其中 CVT 组 92 例,IJVS-CVT 组 107 例。卡方检验显示,CVT 组中存在血栓形成倾向的患者较多,而 IJVS-CVT 组中则较少(83.7%比 20.6%,p<0.001)。多变量逻辑回归分析表明,大多数已确定的血栓形成倾向与 IJVS-CVT 呈负相关(均 p<0.05),包括口服避孕药使用(β=-1.38)、高同型半胱氨酸血症(β=-1.58)、血液学异常(β=-2.05)、蛋白 C/S 缺乏(β=-2.28)、结缔组织病(β=-1.18)和感染(β=-2.77)。所有入组患者均接受标准抗凝治疗,IJVS-CVT 组 10 例患者还接受了颈内静脉血管成形术以纠正 IJVS。大多数患者在 1 年随访期间得到缓解。然而,IJVS-CVT 组的临床和影像学结局均不如 CVT 组(均 p<0.05)。此外,CVT 组 8 例和 IJVS-CVT 组 7 例因 CVT 复发再次住院,并接受了针对性治疗。
非血栓性 IJVS 可能是 CVT 的危险因素之一。对于 IJVS 患者,可能需要建议抗凝治疗。