Clinical characteristics of cerebral venous thrombosis in patients with systemic lupus erythematosus

doi:10.3969/j.issn.1672-6731.2025.06.008

Abstract

Abstract:

Objective: To analyze the clinical manifestations, imaging features, treatment and prognosis of patients with systemic lupus erythematosus (SLE) combined with cerebral venous thrombosis (CVT). Methods and Results: Clinical data of 19 patients with SLE combined with CVT (SLE combined with CVT group) and 38 age and sex matched patients with SLE without CVT (SLE without CVT group) hospitalized in Xuanwu Hospital, Capital Medical University from January 2013 to December 2024 were retrospectively analyzed. SLE combined with CVT group had higher D ‐ dimer (P = 0.001), lupus anticoagulant (P = 0.001), and Systemic Lupus Erythematosus Disease Activity Index ‐ 2000 (SLEDAI ‐ 2000) at admission (P = 0.000) compared with SLE without CVT group. In SLE combined with CVT group, headache (18/19) was the most common neurological symptom. Cerebrospinal fluid (CSF) pressure increased in 14 cases (14/16). The most common cases of thrombosis were transversal sinus (17/19) and sigmoid sinus (17/19). Seventeen cases (17/19) had ≥ 2 venous sinuses involved. Twelve cases had other sites venous thrombosis occurred simultaneously. All patients of SLE combined with CVT group were treated with glucocorticoids, immunosuppressants and anticoagulation therapy. The average follow‐up period was (77.14 ± 33.46) months. During the follow‐up, 16 cases improved, one case died of concurrent infection, and 2 cases were lost to follow ‐ up. Conclusions: CVT is a rare and severity complication of SLE. Headache is the most common neurological symptom, and transversal sinus and sigmoid sinus are the most common sites of thrombosis. For patients of SLE combined with CVT, treatments such as glucocorticoids and immunosuppressants need to be strengthened after venous sinus mechanical thrombectomy. Early recognition and active treatment can obtain good curative effect.

Key words: Lupus erythematosus, systemic, Venous thrombosis, Cerebral veins

摘要：

目的: 总结系统性红斑狼疮（SLE）合并脑静脉血栓形成（CVT）的临床和影像学特征、治疗与预后。方法与结果: 通过电子病历纳入2013年1月至2024年12月首都医科大学宣武医院诊断与治疗的19例系统性红斑狼疮合并脑静脉血栓形成患者（SLE并CVT组）及年龄和性别匹配的38例未合并脑静脉血栓形成的系统性红斑狼疮患者（SLE无CVT组）。与SLE无CVT组相比，SLE并CVT组D‐二聚体（P = 0.001）、狼疮抗凝物阳性比例（P = 0.001）和入院时系统性红斑狼疮疾病活动指数2000（P = 0.000）更高。系统性红斑狼疮合并脑静脉血栓形成患者以头痛为最常见的神经系统症状（18/19）；14例脑脊液压力升高；血栓部位主要位于横窦（17/19）和乙状窦（17/19），17例累及≥ 2个静脉窦，12例同时出现其他部位静脉血栓；均予糖皮质激素、免疫抑制剂及抗凝治疗，平均随访（77.14 ± 33.46）个月，16例好转、1例并发感染死亡、2例失访。结论: 脑静脉血栓形成是系统性红斑狼疮罕见且严重的并发症，头痛是最常见的神经系统症状，主要累及横窦和乙状窦。对于系统性红斑狼疮合并脑静脉血栓形成患者，应加强静脉窦机械取栓术后糖皮质激素及免疫抑制剂治疗，早期识别和积极治疗可获得良好预后。

关键词: 红斑狼疮, 系统性, 静脉血栓形成, 脑静脉

Qiu-ju LIAO, Xiao-yi YANG, Yi ZHAO, Li SU. Clinical characteristics of cerebral venous thrombosis in patients with systemic lupus erythematosus[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(6): 503-508.

廖秋菊, 杨晓艺, 赵义, 苏丽. 系统性红斑狼疮合并脑静脉血栓形成临床特征分析[J]. 中国现代神经疾病杂志, 2025, 25(6): 503-508.

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References 20

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观察指标	SLE无CVT组（n = 38）	SLE并CVT组（n = 19）	统计量值	P值	观察指标	SLE无CVT组（n = 38）	SLE并CVT组（n = 19）统计量值	统计量值	P值
血液系统受累[例（%）]					白蛋白（${\bar x}$ ± s，g/L）	37.25 ± 6.11	36.63 ± 5.93	‐ 0.369	0.714
白细胞计数减少	8（21.05）	5（5/19）	0.012*	0.911	补体C3（${\bar x}$ ± s，g/L）	0.68 ± 0.27	0.74 ± 0.29	0.725	0.473
血红蛋白降低	13（34.21）	4（4/19）	1.048	0.306	补体C4（${\bar x}$ ± s，g/L）	0.13 ± 0.07	0.14 ± 0.07	0.566	0.575
血小板计数减少	5（13.16）	3（3/19）	0.000*	1.000	dsDNA阳性[例（%）]	16（42.11）	12（12/19）	2.246	0.134
肾脏受累[例（%）]	15（39.47）	7（7/19）	0.037	0.847	抗Sm抗体阳性[例（%）]	12（31.58）	4（4/19）	0.695	0.404
肌肉关节受累[例（%）]	18（47.37）	7（7/19）	0.570	0.450	抗RNP抗体阳性[例（%）]	18（47.37）	6（6/19）	1.295	0.255
发热[例（%）]	10（26.32）	6（6/19）	0.174	0.677	SSA阳性[例（%）]	19（50.00）	9（9/19）	0.035	0.851
皮疹[例（%）]	16（42.11）	5（5/19）	1.357	0.244	SSB阳性[例（%）]	3（7.89）	2（2/19）	—	1.000
黏膜溃疡[例（%）]	7（18.42）	4（4/19）	0.000*	1.000	AHA阳性[例（%）]	12（31.58）	5（5/19）	0.168	0.682
浆膜炎[例（%）]	7（18.42）	4（4/19）	0.000*	1.000	ARPA阳性[例（%）]	14（36.84）	3（3/19）	2.682	0.101
ESR [M（P25，P75），mm/h]	20.00 （5.00，39.00）	17.00 （7.00，38.00）	‐ 0.008	0.993	ACA阳性[例（%）]	4（10.53）	4（4/19）	0.454*	0.500
CRP [M（P25，P75），mg/L]	4.00 （1.90，10.00）	3.00 （2.00，14.00）	‐ 0.466	0.641	抗β2‐GP1抗体阳性[例（%）]	5（13.16）	7（7/19）	2.969*	0.085
纤维蛋白原（${\bar x}$ ± s，g/L）	3.37 ± 1.01	3.75 ± 1.45	1.107	0.274	LA阳性[例（%）]	2（5.26）	9（9/19）	11.842*	0.001
D‐二聚体 [M（P25，P75），μg/ml]	0.38 （0.18，1.04）	1.12 （0.71，7.36）	‐ 3.279	0.001	入院时SLEDAI‐2000 （${\bar x}$ ± s，评分）	9.79 ± 5.98	15.74 ± 3.08	4.952	0.000

观察指标	SLE无CVT组（n = 38）	SLE并CVT组（n = 19）	统计量值	P值	观察指标	SLE无CVT组（n = 38）	SLE并CVT组（n = 19）统计量值	统计量值	P值
血液系统受累[例（%）]					白蛋白（${\bar x}$ ± s，g/L）	37.25 ± 6.11	36.63 ± 5.93	‐ 0.369	0.714
白细胞计数减少	8（21.05）	5（5/19）	0.012*	0.911	补体C3（${\bar x}$ ± s，g/L）	0.68 ± 0.27	0.74 ± 0.29	0.725	0.473
血红蛋白降低	13（34.21）	4（4/19）	1.048	0.306	补体C4（${\bar x}$ ± s，g/L）	0.13 ± 0.07	0.14 ± 0.07	0.566	0.575
血小板计数减少	5（13.16）	3（3/19）	0.000*	1.000	dsDNA阳性[例（%）]	16（42.11）	12（12/19）	2.246	0.134
肾脏受累[例（%）]	15（39.47）	7（7/19）	0.037	0.847	抗Sm抗体阳性[例（%）]	12（31.58）	4（4/19）	0.695	0.404
肌肉关节受累[例（%）]	18（47.37）	7（7/19）	0.570	0.450	抗RNP抗体阳性[例（%）]	18（47.37）	6（6/19）	1.295	0.255
发热[例（%）]	10（26.32）	6（6/19）	0.174	0.677	SSA阳性[例（%）]	19（50.00）	9（9/19）	0.035	0.851
皮疹[例（%）]	16（42.11）	5（5/19）	1.357	0.244	SSB阳性[例（%）]	3（7.89）	2（2/19）	—	1.000
黏膜溃疡[例（%）]	7（18.42）	4（4/19）	0.000*	1.000	AHA阳性[例（%）]	12（31.58）	5（5/19）	0.168	0.682
浆膜炎[例（%）]	7（18.42）	4（4/19）	0.000*	1.000	ARPA阳性[例（%）]	14（36.84）	3（3/19）	2.682	0.101
ESR [M（P25，P75），mm/h]	20.00 （5.00，39.00）	17.00 （7.00，38.00）	‐ 0.008	0.993	ACA阳性[例（%）]	4（10.53）	4（4/19）	0.454*	0.500
CRP [M（P25，P75），mg/L]	4.00 （1.90，10.00）	3.00 （2.00，14.00）	‐ 0.466	0.641	抗β2‐GP1抗体阳性[例（%）]	5（13.16）	7（7/19）	2.969*	0.085
纤维蛋白原（${\bar x}$ ± s，g/L）	3.37 ± 1.01	3.75 ± 1.45	1.107	0.274	LA阳性[例（%）]	2（5.26）	9（9/19）	11.842*	0.001
D‐二聚体 [M（P25，P75），μg/ml]	0.38 （0.18，1.04）	1.12 （0.71，7.36）	‐ 3.279	0.001	入院时SLEDAI‐2000 （${\bar x}$ ± s，评分）	9.79 ± 5.98	15.74 ± 3.08	4.952	0.000

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