激素对脑静脉血栓形成无益甚至有害
Are Steroids Useful to Treat Cerebral Venous Thrombosis?Patrícia Canh鉶, MD; Ana Cortes鉶, MD; Marta Cabral, MD; José M. Ferro, MD, PhD; Jan Stam, MD; Marie-Germaine Bousser, MD; Fernando Barinagarrementeria, MD for the ISCVT Investigators
From the Department of Clinical Neurosciences and Mental Health (P.C., A.C., M.C., J.F.), Hospital Santa Maria, Lisboa, Portugal; the Department of Neurology (J.S.), Academic Medical Centre Amsterdam, The Netherlands; the Department of Neurology (M.-G.B.), H魀ital Lariboisière Paris, France; and the Department of Neurology (F.B.), Instituto Nacional de Neurologia y Neurocirurgia, México City, México.
Background and Purpose— No randomized controlled trial has evaluated the efficacy of steroids in acute cerebral venous thrombosis (CVT). We aimed to analyze the effect of steroids on the outcome of patients in the International Study on Cerebral Veins and Dural Sinus Thrombosis (ISCVT).
Methods— ISCVT is a prospective observational study that included 624 CVT patients. Death or dependence at 6 months was compared between cases (patients treated with steroids) and controls (patients not treated with steroids), using 3 designs: (1) Matched case–control study (each case matched with a control for prognostic factors); (2) Nonmatched case–control study of the ISCVT cohort; (3) Case–control study in different strata according to the number of poor prognostic variables in each patient.
Results— One hundred and fifty (24%) patients were treated with steroids. (1) In the matched case–control study, poor outcome was similar in the two groups of patients (26/146 versus 17/149, OR=1.7; 95% CI 0.9 to 3.3, P=0.119). (2) In the ISCVT cohort, no significant difference in poor outcomes was found whether patients were treated with steroids or not (26/146 versus 60/469, OR=1.5; 95% CI 0.9 to 2.4). Patients without parenchymal lesions treated with steroids had worse prognosis than those treated without steroids (8/45 versus 9/184, OR=4.2, 95% CI 1.6 to 11.6, P=0.008). (3) Treatment with steroids was not associated with a better outcome in any strata of patients according to the number of poor prognostic factors.
Conclusions— Steroids in the acute phase of CVT were not useful and were detrimental in patients without parenchymal cerebral lesions. These results do not support the use of steroids in CVT (evidence level III).
为了分析类固醇对急性脑静脉血栓形成（CVT）患者预后的影响，Patrícia Canh鉶博士和同事们在脑静脉和硬脑膜静脉窦血栓形成国际研究（ISCVT）中进行了相关研究 。ISCVT是一项包括624 例CVT患者的前瞻性研究。研究人员采用三种设计方法来比较病例组（接受类固醇治疗的患者）和对照组（未接受类固醇治疗的患者）在6个月时的死亡率或依赖性。三组设计分别是： （ 1 ）配对病例对照研究（根据预后因素为每个病例匹配一个对照）；（ 2 ） ISCVT人群中非配对的病例对照研究；（ 3 ）根据患者所具有的影响预后的变量数目进行不同分层的病例对照研究。
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