Association Between Homocysteinemia And Cerebral Venous Sinus Thrombosis

Objective: Cerebral venous sinus thrombosis(CVST)is a rare cerebral venous system disease characterized by obstructed venous reflux which is caused by a variety of factors.In recent years,previous case reports and case analysis of small samples at home and abroad suggest that homocysteinemia(HCY)may be associated with the onset of CVST.This study aims to investigate the relationship between HCY and CVST onset of population in North China to further explore the etiology of CVST.Method: A case-control study was conducted in this study.67 CVST patients with HCY results were screened from 182 CVST patients admitted to the neurology department of the First Affiliated Hospital of China Medical University from January 2011 to December2019 as case group including 36 males and 31 females.Contemporaneous 135 healthy subjects with HCY results who matched the age,sex with the case group was set as control group including 78 males and 57 females.The clinical data of case group and control group including age,gender,past history,oral contraceptive history,family history,gestation period,perinatal period,clinical symptoms,imaging examination,laboratory examination,etc.were retrospectively analyzed.Differences between the two groups were compared by t-test and ?2 test,logistic regression analysis was used to adjust confounding factors for screening of independent risk factors.Results: 1.Serum homocysteine was higher in the case group than in the control group,the difference was statistically significant(P=0.013).The folate level in the case group was lower than that in the control group,the difference was statistically significant(P=0.001).2.There was no significant difference in clinical symptoms and intracranial lesions between the male and female CVST patients.Inferior sagittal sinus CVST was more commom in male CVST patients than female CVST patients(P=0.031).3.HCY level was significantly higher in male CVST patients than female CVST patients(P=0.007).CVST with hperhomocysteine(HHCY)occurred more often in males than females,the difference was statistically significant(P<0.001).The folate level in CVST patients with HHCY was lower than those with normal HCY level(P=0.004).4.The folate level in female case group was lower than that in female control group.Moderate-severe HHCY was more common in female case group than female control group(P=0.046).5.Higher HCY and d-dimer and lower folate level were found in male case group than male control group.HHCY was more commom in male case group than male control group,the difference was statistically significant(P=0.008).While there was no significant difference in order of severity between case group and control group.6.No relationship between HCY level,HHCY and CVST were found after adjusting for common confounding factors,but folate deficiency was found related to onset of CVST.Elevated HCY level and HHCY were found related to male onset of CVST after a further subgroup analysis based on gender,which may be the independent risk factors for CVST among males,but not among females.Folate deficiency may be the independent risk factors for CVST among both males and females.Conclusion: 1.HCY level increases in CVST patients,HHCY may be the independent risk factors for CVST among males,but not among females.2.Folate deficiency may be the independent risk factors for CVST among both males and females.