Clinical Features And Multivariate Analysis Of Cerebral Venous Sinus Thrombosis In Puerperium

Objective The purpose of this study was to explore the clinical characteristics,risk factors and correlation analysis of the formation of CVST in puerperium.Methods Female outpatients and inpatients admitted to Gansu Provincial Hospital from January 2014 to December 2020 were collected.All CVST patients in puerperium divided into three groups: the case group consisted of 21 CVST patients in puerperium who met the inclusion/exclusion criteria,The puerperium control group included 60 puerperium patients(18 years old ≤ age ≤50 years old)from the Department of Obstetrics of Gansu Provincial Hospital,and the healthy control group included 60 women(18 years old ≤age ≤50 years old)from the physical examination center of Gansu Provincial Hospital.Clinical data of the three groups were collected by cross-sectional study,and SPSS 26.0 was used for statistical analysis.D-dimer,fibrinogen and other laboratory indicators of the three groups were compared to explore the clinical characteristics and risk factors of CVST during puerperium,and the correlation analysis of risk factors was also conducted.Results A total of 24 cases of pregnancy-related CVST were admitted to Gansu Provincial Hospital from January 2014 to December 2020,of which 21 cases(87.5%)occurred during puerperium(16 cases in pre-puerperium and 5 cases in post-puerperium).The most common clinical manifestations were headache(71.4%),followed by nausea and vomiting(33.3%),convulsions(33.3%),focal neurological impairment(57.1%)and disturbance of consciousness(14.3%).Imaging examination showed that the superior sagittal sinus was the most susceptible to involvement(81.0%),followed by transverse sinus(66.7%)and sigmoid sinus(52.4%),and 66.7% of patients had multiple venous sinuses involved.Univariate and multivariate regression analysis showed that HDCP(OR=6.399,95%CI:1.803,52.812,p=0.029)and D-dimer(OR=3.267,95%CI:1.042,10.243,p=0.042)were independent risk factors for the formation of CVST in puerperal period.Correlation analysis showed that D-dimer was positively correlated with FIB(r=0.233,p=0.037)and LDL-C(r=0.247,p=0.026),but negatively correlated with PCT(r=0.292,p=0.008).HDCP was positively correlated with D-dimer(r=0.45,p=0.036)and HCT(r=0.46,p=0.028),but negatively correlated with FIB(r=-0.46,p=0.014),MCH(-r=0.45,p=0.016),and TG(r=-0.53,p=0.005),respectively.Conclusion CVST in puerperium accounts for about 87.5% of pregnancy-related CVST.The common clinical manifestations are headache,focal neurological deficit,nausea,vomiting and convulsions.The most frequently involved venous sinuses are superior sagittal sinus,transverse sinus and sigmoid sinus in order.HDCP and D-dimer are the risk factors for the formation of CVST in puerperium,in which D-dimer was positively correlated with FIB and LDL-C,and negatively correlated with PCT.HDCP was positively correlated with D-dimer and HCT,and negatively correlated with FIB,MCH and TG.