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目的调查脑静脉窦血栓形成(cerebral venous thrombosis,CVT)患者的近期预后,验证CVT预后量表的有效性。方法在单中心观察性研究中,连续性入选2000年5月至2010年5月北京天坛医院CVT患者,进行回顾性分析。通过病例报告表收集患者的人口学信息,症状和体征,诊断方法,血栓的部位等。患者在住院后72 h内完成颅脑磁共振(magnetic resonance imaging,MPI)。评定者依据影像学结果结合基线情况(住院当时症状体征)并完成CVT预后量表评价。随访在患者出院前1 d完成。结局通过改良的Rankin量表(modified Rankin Scale,mRS)评定,mRS≤2分定义为神经功能结局良好。计算CVT的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比,来验证CVT预后量表的有效性。应用受试者工作曲线(Receiver operating characteristic,ROG)分析量表预测的准确性。结果 168名住院CVT患者纳入研究。165名患者在发病17 d(8～45 d)完成量表评价。随访时,130名患者(78.8%)预后良好(mRS≤2),CVT预后评分选择≥3分为分界点,量表预测的敏感性、特异性和ROC曲线下面积分别为0.75[95%可信区间(confidence interval,CI)0.67～0.82],0.38(95%CI0.22～0.55)和0.56(95%CI 0.45～0.68,P>0.05);当选择≥4分为分界点时,敏感性、特异性和ROc曲线下面积分别为0.85(95%CI 0.78～0.91),特异性0.35(95%CI 0.19～0.51)和0.60(95%CI0.49～0.71,P=0.074>0.05)。结论 CVT患者出院时预后相对良好,仍有部分患者预后不良(21.2%)。在本研究中,CVT预后量表准确性不理想,需要进一步前瞻性验证。
Objective To investigate the short-term prognosis of patients with cerebral venous thrombosis (CVT) and verify the validity of CVT prognosis scale. Methods In a single-center observational study, patients with CVT in Beijing Tiantan Hospital from May 2000 to May 2010 were retrospectively analyzed. Demographic information, symptoms and signs, diagnostic methods, sites of thrombus, etc., are collected through the case report form. Patients completed magnetic resonance imaging (MPI) within 72 h of hospitalization. The assessors combined baseline findings (hospital-acquired symptoms and signs) and completed the CVT Outcome Scale based on the imaging findings. Follow-up was completed 1 day before patient discharge. Outcomes were assessed by a modified Rankin Scale (mRS), and mRS ≤ 2 was defined as a good neurological outcome. The CVT sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated to verify the validity of CVT prognosis scale. Receiver operating characteristic (ROG) was used to analyze the accuracy of the scale prediction. Results 168 hospitalized patients with CVT were included in the study. 165 patients in the onset of 17 d (8 ~ 45 d) to complete the scale evaluation. At follow-up, 130 patients (78.8%) had a good prognosis (mRS ≤ 2) and CVT prognosis scores ≥ 3 as cut-off points. The sensitivity, specificity, and area under the ROC curve for the scale were 0.75 Confidence interval (CI) 0.67 ~ 0.82], 0.38 (95% CI0.22 ~ 0.55) and 0.56 (95% CI 0.45 ~ 0.68, P> 0.05) , Specificity and area under the ROc curve were 0.85 (95% CI 0.78-0.91), 0.35 (95% CI 0.19-0.51) and 0.60 (95% CI 0.49-0.71, P = 0.074> 0.05), respectively. Conclusion The prognosis of patients with CVT is relatively good at discharge, and some patients still have a poor prognosis (21.2%). In this study, the accuracy of the CVT prognosis scale was not satisfactory and further prospective validation was needed.