The Diagnostic Value Of Determination Of Plasma D-dimer In Cerebral Venous Sinus Thrombosis During Pregnancy

Background and Objective:Cerebral venous sinus thrombosis, (cerebral venous sinus thrombosis,CVST) is the relatively high incidence in women with gestational period of acute vascular diseases of nervous system, The cause of many and complex, partly because of unknown clinical manifestations of complex, non-typical regularity and lack of accepted diagnostic process, so often confusing for clinicians。Pregnancy CVST main cause cerebral venous return and cerebrospinal fluid malabsorption, leading to increased intracranial pressure and a corresponding focal symptoms. Causes and parts with different clinical manifestations vary, often misdiagnosed as central nervous system infections, angioneurotic headache, brain infarction. cerebral hemorrhage, intracranial lesions and benign intracranial hypertension, and thus lead to wrong treatment. Pregnancy CVST early treatment can make the mortality rate dropped significantly, especially in the progress faster, soon coma patients, timely and effective treatment is the key to reduce mortality. Therefore, to reduce the misdiagnosis, correct diagnosis and effective treatment of CVST is most important for neurologists faced. Although the brain computed tomography (CT), magnetic resonance imaging on veins (MRV) cerebral angiography and digital subtraction angiography (DSA) were diagnosed CVST clues can be found or directly clear CVST patients, but because of the particularity of pregnancy women’s health, the more reluctant to accept radioactive inspection.So find a cheap and can make the early diagnosis of test indexes become the focus of current research. D-dimer is derived from the fibrinolytic enzymes crosslinked fibrin clot dissolves, their increased in secondary fibrinolysis function or high coagulation state, thrombolytic therapy, etc. Purpose of this study is to observe D-dimer in the expression of CVST patients during pregnancy, discusses its significance in the diagnosis of patients with CVST during pregnancy.Materials and methods:This study collected from September 2012 to September 2014 in Beijing xuanwu hospital, since zaozhuang maternal and child health care and zaozhuang city hospital and medical record information complete clinical data of 52 cases of pregnancy CVST patients, among them,12 cases of early pregnancy,19 cases of mid pregnancy, 21 cases of late pregnancy,52 cases of pregnancy patients with CVST D-dimer test results were retrospectively analyzed. Observe D-dimer in different age groups, have disease in different periods, the different parts and different gestation period of change in value. All materials are established using Excel analysis database, SPSS17.0 statistical software package is used to analyse the data, experimental data are analyzed with X2 test, P<0.05 was statistically significant.Results:1.52 cases of pregnancy CVST patients between different age groups to compare D-dimer level there was no significant difference (P> 0.05).2.Pregnancy CVST patients have disease was detected in "acute phase (< 5 days)", "subacute phase (5-15 days)", "chronic phase (> 16 days)" D-dimer level positive rate at each stage respectively,100%,91.30% and 62.50%, the acute phase D-dimer content most in the 1000-2000 ug/L and>2000 ug/L, subacute phase concentrated in 500-1000 ug/L and 1000-2000 ug/L, and in the chronic phase D-dimer content concentrated in the< 500 ug/L and 500-500 ug/L3.Pregnancy CVST, according to the cumulative site group, each group D-dimer value comparison, superior sagittal sinus and sagittal sinus under no significant difference (P> 0.05), D-dimer value most in 1000-2000 ug/L distribution, positive rate was respectively 88.89% and 71.42%. And transverse sinus, sigmoid sinus and many parts involved and the comparison between the two type of group, significant differences (P< 0.05), D-dimer value distribution in 1000-2000 ug/L and> 2000 ug/L, the positive rate was respectively 95.23% and 95.23%.4.According to gestational weeks Pregnancy CVST patients can be divided into early pregnancy, mid pregnancy and late pregnancy, Periods in patients with CVST in D-dimmer, significant difference between groups (P< 0.05), the early pregnancy patients with CVST D-dimer content most in 500-1000 ug/L distribution, positive rate was 75.00%. And mid pregnancy patients with CVST D-dimer content most distribution,in 1000-2000 ug/L positive rate was 94.73%. Late pregnancy patients with CVST D-dimer most distribution in> 2000 ug/L, positive rate was 95.23%.Conclusion:1.Pregnancy patients with CVST D-dimer content has no obvious correlation with the patient age.2. Pregnancy CVST patients in acute stage D-dimer check-up positive rate and the rate is higher than subacute and chronic phase, which is suitable for emergency patients and basic-level hospitals screening application.3.Pregnancy CVST involving the more extensive venous sinus, thrombus area, the greater the D-dimer positive rate is higher, the higher the value of D-dimer.4. The longer pregnancy, placental villi damage, the more risk factors lead to CVST, D-dimer content is higher.5.D-dimer can be as an important diagnostic index of CVST patients during pregnancy, can also be used as screening index of exclusion of pregnancy CVST.