硬膜穿刺与活化蛋白C抵抗：脑静脉窦血栓形成的危险因素。
Dural puncture and activated protein C resistance: risk factors for cerebral venous sinus thrombosis.
作者信息
Wilder-Smith E, Kothbauer-Margreiter I, Lämmle B, Sturzenegger M, Ozdoba C, Hauser S P
机构信息
Department of Neurology, Inselspital, University Hospital Bern, Switzerland.
出版信息
J Neurol Neurosurg Psychiatry. 1997 Sep;63(3):351-6. doi: 10.1136/jnnp.63.3.351.
OBJECTIVES
Dural puncture is regarded a safe procedure when contraindications are carefully excluded and has so far not been recognised as a risk factor for cerebral venous sinus thrombosis (CVST). Five patients are described with CVST after dural puncture in the presence of additional risk factors.
METHODS
In four out of five patients complete investigations for thrombophilia were performed at least one month after withdrawal of oral anticoagulation.
RESULTS
In three out of four patients tested, activated protein C (APC) resistance due to heterozygous coagulation factor V R506Q mutation (factor V Leiden) was found. One patient was using oral contraceptives as a circumstantial risk factor and three had had spinal anaesthesia for surgical procedures. Family history of venous thromboembolism was negative in all patients. Retrospective evaluation of 66 patients with CVST disclosed that dural puncture was the fourth most common risk factor (8%) possibly contributing to thrombosis.
CONCLUSION
Dural puncture may constitute an additional risk factor for CVST especially in patients with APC resistance or surgery. In such patients a thrombophilia screen is indicated.
目的
当仔细排除禁忌症时，硬膜穿刺被视为一种安全的操作，并且迄今为止尚未被认为是脑静脉窦血栓形成（CVST）的危险因素。本文描述了5例在存在其他危险因素的情况下硬膜穿刺后发生CVST的患者。
方法
5例患者中有4例在停用口服抗凝药至少1个月后进行了全面的血栓形成倾向检查。
结果
在接受检测的4例患者中有3例发现由于杂合子凝血因子V R506Q突变（因子V莱顿）导致的活化蛋白C（APC）抵抗。1例患者将口服避孕药作为偶然的危险因素，3例因外科手术接受了脊髓麻醉。所有患者的静脉血栓栓塞家族史均为阴性。对66例CVST患者的回顾性评估显示，硬膜穿刺是可能导致血栓形成的第四大常见危险因素（8%）。
结论
硬膜穿刺可能是CVST的一个额外危险因素，尤其是在存在APC抵抗或接受手术的患者中。对于此类患者，建议进行血栓形成倾向筛查。
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