妊娠相关颅内静脉窦血栓研究进展

doi:10.3969/j.issn.1673-5765.2018.05.025

摘要/Abstract

摘要：

颅内静脉窦血栓（cerebral venous sinus thrombosis，CVST）是指由于多种病因引起的脑静脉回流受阻、颅内高压为特征的特殊类型的脑血管病，具有较高死亡率。成年女性则以口服避孕药物和围产期多见。由于妊娠引起的CVST危险因素较多，发病机制复杂，早期对妊娠合并CVST的诊治具有一定难度。本文结合近几年国内外对妊娠相关CVST的病因和发病机制、临床表现和辅助检查、治疗等几个方面的研究进展进行阐述，以期早期发现、优化治疗方案，降低死亡率，为临床诊治提供依据。

文章导读： 对于女性，妊娠期、口服避孕药、激素替代治疗、辅助生殖技术等都可导致颅内静脉窦血栓风险升高，影像学技术及生化指标有助于其诊断。

关键词: 颅内静脉窦血栓; 妊娠; 病因; 病理生理机制

Abstract:

Cerebral venous sinus thrombosis (CVST) is a rare type of cerebrovascular disease, with the features of obstruction of cerebrospinal fluid and elevated intracranial pressure. It is a rare disorder with a relative higher mortality. It is also an important cause of stroke in female adults, especially at the stage of perinatal period and with oral contraceptive. There are some difficulties in early diagnosis of CVST in pregnant females, because of multiple risk factors and complex pathogenesis. This review mainly focuses on the etiology, pathophysiology, clinical manifestation, assist examination and treatment of CVST so as to diagnose at early stage, reduce mortality, optimize the therapeutic protocol, and provide important reference for clinical diagnosis and treatment.

Key words: Cerebral venous sinus thrombosis; Pregnancy; Etiology; Pathophysiology

王晴, 袁俊亮. 妊娠相关颅内静脉窦血栓研究进展[J]. 中国卒中杂志, 2018, 13(05): 527-531.

WANG Qing, YUAN Jun-Liang. Progress on Pregnancy-Associated Cerebral Venous Sinus Thrombosis[J]. Chinese Journal of Stroke, 2018, 13(05): 527-531.

参考文献

[1] BOUSSER M G，FERRO J M. Cerebral venous

thrombosis：an update[J]. Lancet Neurol，2007，6 （2）：162-170.

[2] BOUSSER M G，CRASSARD I. Cerebral venous

thrombosis，pregnancy and oral contraceptives[J/

OL]. Thromb Res，2012，130（Suppl 1）：S19-S22.

https：//doi.org/10.1016/j.thromres.2012.08.264.

[3] CANTU-BRITO C，ARAUZ A，ABURTO Y，et

al. Cerebrovascular complications during pregnancy

and postpartum：clinical and prognosis observations

in 240 Hispanic women[J]. Eur J Neurol，2011，18

（6）：819-825.

[4] SILVIS S M，MIDDELDORP S，ZUURBIER

S M，et al. Risk Factors for Cerebral Venous

Thrombosis[J]. Semin Thromb Hemost，2016，42（6）：

622-631.

[5] FERRO J M，BOUSSER M G，CANHAO P，et

al. European Stroke Organization guideline for

the diagnosis and treatment of cerebral venous

thrombosis - endorsed by the European Academy of

Neurology[J]. Eur J Neurol，2017，24（10）：1203-

1213.

[6] ZUURBIER S M，MIDDELDORP S，STAM J，et

al. Sex differences in cerebral venous thrombosis：

A systematic analysis of a shift over time[J]. Int J

Stroke，2016，11（2）：164-170.

[7] FERRO J M，CANHAO P. Cerebral venous sinus

thrombosis：update on diagnosis and management[J].

Curr Cardiol Rep，2014，16（9）：523.

[8] PONCE E，COTTIER J P，GRUEL Y，et al. Cerebral

venous thrombosis in an elderly adult treated with

diethylstilbestrol[J]. J Am Geriatr Soc，2013，61（7）：

1242-1243.

[9] Coutinho J M. Cerebral venous thrombosis[J/OL]. J

Thromb Haemost，2015，13（Suppl 1）：S238-S244.

https：//doi.org/10.1111/jth.12945.

[10] AGUIAR DE SOUSA D，CANHAO P，FERRO J M.

Safety of pregnancy after cerebral venous thrombosis：

systematic review update[J]. J Neurol，2018，265（1）：

211-212.

[11] BANERJEE C. Obesity，Oral Contraceptive Use，

and Cerebral Venous Thrombosis in Women[J].

JAMA Neurol，2016，73（5）：512-513.

[12] AMOOZEGAR F，RONKSLEY P E，SAUVE R，et

al. Hormonal contraceptives and cerebral venous

thrombosis risk：a systematic review and metaanalysis[

J/OL]. Front Neurol，2015，6：7. https：//doi.

org/10.3389/fneur.2015.00007.

[13] MATTI A I，LEE A W，CHEN C S. Concurrent

branch retinal vein occlusion and cerebral venous

thrombosis from oral contraceptive pill use[J]. Can J

Ophthalmol，2010，45（5）：541-542.

[14] HORGA A，SANTAMARINA E，QUILEZ A，et al. Cerebral venous thrombosis associated with repeated

use of emergency contraception[J/OL]. Eur J Neurol，

2007，14（4）：e5. https：//doi.org/10.1111/j.1468-

1331.2006.01646.x.

[15] ZAVANONE C，PANEBIANCO M，YGER M，et

al. Cerebral venous thrombosis at high altitude：A

systematic review[J]. Rev Neurol（Paris），2017，173

（4）：189-193.

[16] OZDEMIR H H，VAROL S，AKIL E，et al.

Evaluation of cerebral venous thrombosis secondary

to oral contraceptive use in adolescents[J]. Neurol

Sci，2015，36（1）：149-153.

[17] SIDHOM Y，MANSOUR M，MESSELMANI M，

et al. Cerebral venous thrombosis：clinical features，

risk factors，and long-term outcome in a Tunisian

cohort[J]. J Stroke Cerebrovasc Dis，2014，23（6）：

1291-1295.

[18] SIDOROV E V，FENG W，CAPLAN L R. Stroke

in pregnant and postpartum women[J]. Expert Rev

Cardiovasc Ther，2011，9（9）：1235-1247.

[19] AGUIAR DE SOUSA D，CANHAO P，CRASSARD

I，et al. Safety of Pregnancy After Cerebral Venous

Thrombosis：Results of the ISCVT（International

Study on Cerebral Vein and Dural Sinus

Thrombosis）-2 PREGNANCY Study[J]. Stroke，

2017，48（11）：3130-3133.

[20] RAZMARA A，BAKHADIROV K，BATRA A，et

al. Cerebrovascular complications of pregnancy and

the postpartum period[J]. Curr Cardiol Rep，2014，16

（10）：532.

[21] O'BRIEN P，HEANEY D. Cerebrovascular

complications during pregnancy and the

puerperium[J]. Eur J Neurol，2011，18（6）：801-802.

[22] MUELLER-MANG C，MANG T，PIRKER A，et al.

Posterior reversible encephalopathy syndrome：do

predisposing risk factors make a difference in MRI

appearance?[J]. Neuroradiology，2009，51（6）：373-

383.

[23] COLLINS P. Clinical cardiovascular studies of

hormone replacement therapy[J/OL]. Am J Cardiol，

2002，90（1a）：30f-34f. https：//doi.org/10.1016/

S0002-9149（01）02220-2.

[24] LO Y C，TSAI J L，TSAI I T，et al. Headache，

oestrogens，homocysteinaemia and cerebral venous

thrombosis[J]. QJM，2016，109（10）：685-686.

[25] SCARABIN P Y. Hormone therapy and venous

thromboembolism among postmenopausal women[J/

OL]. Front Horm Res，2014，43：21-32. https：//doi.

org/10.1159/000360554.

[26] LAMAZOU F，LEGOUEZ A，LETOUZEY

V，et al. Ovarian hyperstimulation syndrome：pathophysiology，risk factors，prevention，diagnosis

and treatment[J]. J Gynecol Obstet Biol Reprod

（Paris），2011，40（7）：593-611.

[27] MAN B L，HUI A C. Cerebral venous thrombosis

secondary to ovarian hyperstimulation syndrome[J].

Hong Kong Med J，2011，17（2）：155-156.

[28] HASSA H，AYDIN Y，OGE T，et al. Incompletely

Evaluated ART Leading to Ectopic Pregnancy and

Cerebral Thrombosis[J]. Int J Fertil Steril，2013，7

（2）：138-141.

[29] 袁俊亮，王双坤，郭晓娟，等. 卵巢过度刺激综合

征合并系统性红斑狼疮、甲状腺功能减退引起的

静脉窦血栓一例[J]. 中华医学杂志，2015，95（28）：

2322-2323.

[30] YANG S，YUAN J，QIN W，et al. The Clinical

Characteristics of Acute Cerebrovascular Accidents

Resulting from Ovarian Hyperstimulation

Syndrome[J]. Eur Neurol，2017，77（5-6）：221-230.

[31] 赵久良，张瑶，孙伊多，等. 抗磷脂综合征并发颅内

静脉窦血栓临床特点[J]. 中华临床免疫和变态反应

杂志，2016，1（10）：4-9.

[32] RIZZO L，CRASTO S G，RUDA R，et al. Cerebral

venous thrombosis：role of CT，MRI and MRA in

the emergency setting[J]. Radiol Med，2010，115（2）：

313-325.

[33] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国颅内静脉系统血栓形成诊断

和治疗指南2015[J]. 中华神经科杂志，2015，48（10）：

819-829.

[34] YANG Q，DUAN J，FAN Z，et al. Early Detection

and Quantification of Cerebral Venous Thrombosis by Magnetic Resonance Black-Blood Thrombus

Imaging[J]. Stroke，2016，47（2）：404-409.

[35] MECKEL S，REISINGER C，BREMERICH J，et al.

Cerebral venous thrombosis：diagnostic accuracy of

combined，dynamic and static，contrast-enhanced

4D MR venography[J]. AJNR Am J Neuroradiol，

2010，31（3）：527-535.

[36] NIU P P，YU Y，GUO Z N，et al. Diagnosis of

non-acute cerebral venous thrombosis with 3D T1-

weighted black blood sequence at 3T[J/OL]. J Neurol

Sci，2016，367：46-50. https：//doi.org/10.1016/

j.jns.2016.05.052.

[37] ALONS I M，JELLEMA K，WERMER M J，et

al. D-dimer for the exclusion of cerebral venous

thrombosis：a meta-analysis of low risk patients

with isolated headache[J/OL]. BMC Neurol，2015，15：

118. https：//doi.org/10.1186/s12883-015-0389-y.

[38] MAKANJUOLA A I，FAROMBI T H，YARIA J

O，et al. Cerebral Venous Thrombosis，Protein S

Deficiency and Pregnancy Triad：A Case Report[J].

West Afr J Med，2015，34（3）：201-205.

[39] BUSHNELL C，SAPOSNIK G. Evaluation and

management of cerebral venous thrombosis[J/OL].

Continuum（Minneap Minn），2014，20：335-351.

https：//doi.org/10.1212/01.CON.0000446105.67173.

a8.

[40] EDLOW J A，CAPLAN L R，O'BRIEN K，et al.

Diagnosis of acute neurological emergencies in

pregnant and post-partum women[J]. Lancet Neurol，

2013，12（2）：175-185.