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Abstract：
BACKGROUND: Exposure to a high-altitude environment is a risk factor for cerebral venous thrombosis (CVT) probably due to hypercoagulability. The study aims to explore the unique characteristics of CVT patients in high-altitude areas of China by comparing them with those in plain areas.
METHODS: We retrospectively included consecutive patients with CVT admitted to Tibet Autonomous Region People\'s Hospital (altitude 3650 m) and Peking Union Medical College Hospital (altitude 43.5 m) between January 2015 and December 2023. Patients from the plateau and the plain were considered two independent groups in this study. The risk factors, clinical and radiological presentations, treatment, and outcomes were analyzed and compared between the two groups.
RESULTS: A total of 169 patients with CVT were included in the study, 48 patients from plateau and 121 patients from plain. The median age was 27 and 34 years old, and women accounted for 66.7% and 54.5% respectively. Headache (91.7% vs. 71.1%, P = 0.004), altered consciousness (31.3% vs. 16.5%, P = 0.033), hemorrhage (41.7% vs. 19.0%, P = 0.002), and venous infarction (50.0% vs. 25.6%, P = 0.002) on imaging were more common in patients from plateau than those from plain. Pregnancy or puerperium was significantly more common in highland patients (25% vs. 5.8%, P < 0.001). The levels of D-Dimer (1.7 vs. 0.8 mg/L FEU, P = 0.01), fibrinogen (3.7 vs. 3.0 g/L, P < 0.001), hemoglobin (157 vs. 129 g/L, P = 0.01), white blood cells (9.6 vs. 7.5*1012/L, P < 0.001) and highly sensitive C-reactive protein (20.2 vs. 3.2 mg/L, P = 0.005) were remarkably higher in highland patients. The percentage of receiving anticoagulant therapy was lower in high-altitude patients (70.8% vs. 93.4%, P < 0.001). Favorable outcome at follow-up was observed in 81.4% of highland patients and 90.7% of lowland patients, with a median follow-up time of 330 days and 703 days respectively.
CONCLUSIONS: The more severe clinical and imaging manifestations along with prominent inflammatory and hypercoagulable states were observed in plateau CVT patients, probably due to exposure to the hypoxic environment at high altitude. Pregnancy or puerperium were more common in highland patients. The overall prognosis of CVT patients from both groups were favorable.
METHODS: We retrospectively included consecutive patients with CVT admitted to Tibet Autonomous Region People\'s Hospital (altitude 3650 m) and Peking Union Medical College Hospital (altitude 43.5 m) between January 2015 and December 2023. Patients from the plateau and the plain were considered two independent groups in this study. The risk factors, clinical and radiological presentations, treatment, and outcomes were analyzed and compared between the two groups.
RESULTS: A total of 169 patients with CVT were included in the study, 48 patients from plateau and 121 patients from plain. The median age was 27 and 34 years old, and women accounted for 66.7% and 54.5% respectively. Headache (91.7% vs. 71.1%, P = 0.004), altered consciousness (31.3% vs. 16.5%, P = 0.033), hemorrhage (41.7% vs. 19.0%, P = 0.002), and venous infarction (50.0% vs. 25.6%, P = 0.002) on imaging were more common in patients from plateau than those from plain. Pregnancy or puerperium was significantly more common in highland patients (25% vs. 5.8%, P < 0.001). The levels of D-Dimer (1.7 vs. 0.8 mg/L FEU, P = 0.01), fibrinogen (3.7 vs. 3.0 g/L, P < 0.001), hemoglobin (157 vs. 129 g/L, P = 0.01), white blood cells (9.6 vs. 7.5*1012/L, P < 0.001) and highly sensitive C-reactive protein (20.2 vs. 3.2 mg/L, P = 0.005) were remarkably higher in highland patients. The percentage of receiving anticoagulant therapy was lower in high-altitude patients (70.8% vs. 93.4%, P < 0.001). Favorable outcome at follow-up was observed in 81.4% of highland patients and 90.7% of lowland patients, with a median follow-up time of 330 days and 703 days respectively.
CONCLUSIONS: The more severe clinical and imaging manifestations along with prominent inflammatory and hypercoagulable states were observed in plateau CVT patients, probably due to exposure to the hypoxic environment at high altitude. Pregnancy or puerperium were more common in highland patients. The overall prognosis of CVT patients from both groups were favorable.
摘要：
背景：暴露于高海拔环境是脑静脉血栓形成（CVT）的危险因素，可能是由于高凝状态。本研究旨在通过与平原地区CVT患者的比较,探讨我国高海拔地区CVT患者的独特特征。
方法：回顾性纳入2015年1月至2023年12月在西藏自治区人民医院（海拔3650m）和北京协和医院（海拔43.5m）连续收治的CVT患者。在这项研究中，来自高原和平原的患者被认为是两个独立的组。风险因素,临床和放射学表现，治疗,并对两组的结局进行分析比较。
结果：总共169名CVT患者被纳入研究，高原48例，平原121例。平均年龄为27岁和34岁，女性分别占66.7%和54.5%。头痛（91.7％vs.71.1%,P=0.004),意识改变（31.3%vs.16.5%,P=0.033),出血（41.7%vs.19.0%,P=0.002),和静脉梗死（50.0%vs.25.6%,P=0.002）在影像学上更常见于高原患者。妊娠或产褥期在高原患者中明显更常见（25％与5.8%,P<0.001)。D-二聚体水平（1.7vs.0.8mg/LFEU，P=0.01),纤维蛋白原（3.7vs.3.0g/L,P<0.001)，血红蛋白（157vs.129g/L,P=0.01),白细胞（9.6vs.7.5*1012/L,P<0.001）和高度敏感的C反应蛋白（20.2vs.3.2mg/L,高原患者的P=0.005）明显更高。高海拔地区患者接受抗凝治疗的比例较低(70.8%vs.93.4%,P<0.001)。在81.4％的高原患者和90.7％的低地患者中观察到良好的随访结果，中位随访时间分别为330天和703天。
结论：在高原CVT患者中观察到更严重的临床和影像学表现以及突出的炎症和高凝状态。可能是由于暴露于高海拔的低氧环境。妊娠或产褥期在高原患者中更为常见。两组CVT患者的总体预后均良好。
方法：回顾性纳入2015年1月至2023年12月在西藏自治区人民医院（海拔3650m）和北京协和医院（海拔43.5m）连续收治的CVT患者。在这项研究中，来自高原和平原的患者被认为是两个独立的组。风险因素,临床和放射学表现，治疗,并对两组的结局进行分析比较。
结果：总共169名CVT患者被纳入研究，高原48例，平原121例。平均年龄为27岁和34岁，女性分别占66.7%和54.5%。头痛（91.7％vs.71.1%,P=0.004),意识改变（31.3%vs.16.5%,P=0.033),出血（41.7%vs.19.0%,P=0.002),和静脉梗死（50.0%vs.25.6%,P=0.002）在影像学上更常见于高原患者。妊娠或产褥期在高原患者中明显更常见（25％与5.8%,P<0.001)。D-二聚体水平（1.7vs.0.8mg/LFEU，P=0.01),纤维蛋白原（3.7vs.3.0g/L,P<0.001)，血红蛋白（157vs.129g/L,P=0.01),白细胞（9.6vs.7.5*1012/L,P<0.001）和高度敏感的C反应蛋白（20.2vs.3.2mg/L,高原患者的P=0.005）明显更高。高海拔地区患者接受抗凝治疗的比例较低(70.8%vs.93.4%,P<0.001)。在81.4％的高原患者和90.7％的低地患者中观察到良好的随访结果，中位随访时间分别为330天和703天。
结论：在高原CVT患者中观察到更严重的临床和影像学表现以及突出的炎症和高凝状态。可能是由于暴露于高海拔的低氧环境。妊娠或产褥期在高原患者中更为常见。两组CVT患者的总体预后均良好。
