糖皮质激素联合抗凝在急性/亚急性重症颅内静脉血栓治疗中的探索

doi:10.3969/j.issn.1006-7795.2023.02.015

首都医科大学学报 ›› 2023, Vol. 44 ›› Issue (2): 280-288.doi: 10.3969/j.issn.1006-7795.2023.02.015

糖皮质激素联合抗凝在急性/亚急性重症颅内静脉血栓治疗中的探索

胡舒缘^1,2，张开元³，谷亚钦²，李京凯³，周陈⁴，吉训明²，段建钢^1,2*

1.首都医科大学宣武医院急诊科，北京 100053； 2.首都医科大学宣武医院神经内科，北京 100053； 3.首都医科大学宣武医院影像与核医学科，北京 100053； 4.北京脑重大疾病研究院，北京 100069

收稿日期:2022-12-07 出版日期:2023-04-21 发布日期:2023-04-18
通讯作者: 段建钢 E-mail:duanjiangang@xwhosp.org
基金资助:
北京市自然科学基金（7182064）

Exploration of glucocorticoid combined with anticoagulation in acute/subacute severe cerebral venous thrombosis

Hu Shuyuan1,2, Zhang Kaiyuan³, Gu Yaqin², Li Jingkai³, Zhou Chen⁴, Ji Xunming², Duan Jiangang^1,2*

1.Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053，China; 2.Department of Neurology, Xuanwu Hospital, Capital Medical University，Beijing 100053，China; 3.Department of Imaging and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing100053，China; 4.Beijing Institute of Brain Disorders, Beijing 100069，China

Received:2022-12-07 Online:2023-04-21 Published:2023-04-18
Supported by:
This study was supported by Natural Science Foundation of Beijing (7182064)

摘要/Abstract

摘要： 目的本研究初步探讨糖皮质激素联合抗凝治疗在急性/亚急性重症颅内静脉血栓（cerebral venous thrombosis, CVT）中的作用。方法纳入10例经过糖皮质激素联合抗凝治疗的急性/亚急性重症CVT患者，对治疗前后及出院3个月时的神经功能缺损、颅内压增高情况和血清、脑脊液炎症指标及不良事件进行回顾性分析。结果 10例患者经过糖皮质激素冲击治疗后2周，与入院时基线值相比，血清中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）（P＜0.05），超敏C反应蛋白(hypersensitive C-reactive protein，hs-CRP）（P＜0.01），白细胞介素-6（interleukin 6，IL-6）（P＜0.01）和脑脊液IL-6浓度（P＜0.01）均明显下降；与入院时基线值相比，出院时改良Rankin量表（modified Rankin Scale, mRS）评分（P＜0.01）、美国国立卫生研究院卒中评分（National Institutes of Health Stroke Score, NIHSS）（P＜0.01）和颅内压（P＜0.01）均明显下降；出院3个月时mRS、NIHSS进一步下降（P＜0.01）。在住院及随访期间，10例患者均未出现静脉血栓复发、自发性骨折或骨坏死等激素相关的严重不良反应。结论短期应用糖皮质激素联合抗凝治疗对急性/亚急性重症CVT患者可能安全、有效。

关键词: 重症颅内静脉血栓形成, 急性/亚急性期, 糖皮质激素, 抗凝, 预后

Abstract: Objective To preliminarily investigate the application of glucocorticoid combined with anticoagulant therapy in acute/subacute severe cerebral venous thrombosis (CVT) through a case series. Methods Ten patients with acute/subacute severe CVT who were successfully treated with glucocorticoid combined with anticoagulation were enrolled in this study. Neurological deficits, increased intracranial pressure, serum and cerebrospinal fluid inflammatory markers and adverse events were retrospectively analyzed before and after treatment and at 3 months after discharge. Results Compared with baseline, serum neutrophil-to-lymphocyte ratio（NLR） (P＜0.05),hypersensitive C-reactive protein（hs-CRP）(P＜0.01), interleukin 6（IL-6） (P＜0.01) and cerebrospinal fluid IL-6 (P＜0.01) were significantly decreased in 10 patients at 2 weeks after glucocorticoid pulse therapy; Modified Rankin Scale（mRS） (P＜0.01), National Institutes of Health Stroke Score（NIHSS） (P＜0.01) and intracranial pressure (P＜0.01) were significantly decreased at discharge. At 3 months after discharge, mRS （P＜0.01） and NIHSS （P＜0.01） further decreased. Ten patients had no steroid-related serious adverse reactions such as venous thrombosis recurrence, spontaneous fracture, or osteonecrosis during hospitalization and follow-up. Conclusion Short-term use of glucocorticoid combined with anticoagulation may be safe and effective in patients with acute/subacute severe CVT.

Key words: severe cerebral venous thrombosis, acute/subacute phase, glucocorticoid, anticoagulation, prognosis

中图分类号:

R743

胡舒缘, 张开元, 谷亚钦, 李京凯, 周陈, 吉训明, 段建钢. 糖皮质激素联合抗凝在急性/亚急性重症颅内静脉血栓治疗中的探索[J]. 首都医科大学学报, 2023, 44(2): 280-288.

Hu Shuyuan, Zhang Kaiyuan, Gu Yaqin, Li Jingka, Zhou Chen, Ji Xunming, Duan Jiangang. Exploration of glucocorticoid combined with anticoagulation in acute/subacute severe cerebral venous thrombosis[J]. Journal of Capital Medical University, 2023, 44(2): 280-288.

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糖皮质激素联合抗凝在急性/亚急性重症颅内静脉血栓治疗中的探索

Exploration of glucocorticoid combined with anticoagulation in acute/subacute severe cerebral venous thrombosis

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