子痫前期-子痫患者合并可逆性后部白质脑病综合征的临床特征  

Clinical features of preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome

作　　者：卢红艳[1] 谢炳均[1] 程焱[1] 牛秀敏[2] 

机构地区：[1]天津医科大学总医院神经内科,300052 [2]天津医科大学总医院妇产科,300052

出　　处：《中华医学杂志》2010年第3期178-181,共4页National Medical Journal of China

摘　　要：目的探讨子痫前期．子痫患者合并可逆性后部白质脑病综合征（RPLS）的临床和影像学特征。方法分析20例子痫前期．子痫合并RPLS患者的临床、实验室、影像学资料及随访结果，与同期住院行MRI检查结果为阴性的子痫前期-子痫患者15例相比较。结果子痫前期-子痫合并RPLS患者较对照组更容易出现剧烈头痛、视物模糊、癫痫发作、意识障碍或精神异常；影像学显示双侧大脑后部为主的大片对称性白质水肿，经过及时有效的治疗患者临床症状和影像学改变可以完全恢复。合并RPLS的患者血尿酸水平（442±77）mmol／L明显高于对照组（350±88）mmol／L（P〈0．05）。两组间血压及其他实验室检查结果无明显不同。结论子痫或子痫前期合并RPKS患者具有特征性的临床和影像学表现，经积极治疗，预后良好。血管内皮损伤可能是RPLS发病的重要因素，临床对子痫前期-子痫患者监测血尿酸水平有助于早期发现RPLS。Objective To investigate the clinical features and specific characteristics of magnetic resonance image （MRI） in preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome （RPLS）. Methods The investigators analyzed the combined clinical, laboratory and neuroradiographic features of 20 preeclampsia-eclarnpsia patients with RPLS and 15 preeclampsia-clampsia controls with normal MRI findings. Results Patients with RPKS had more tendency to have headache, seizure, visual disturbance, confusion and altered mental status than controls. Neuroimaging showed diffuse edema predominantly in posterior cerebral white matter bilaterally. Clinical features and neuroradiological alterations disappeared after appropriate treatments were started. Twenty RPLS patients had a significantly higher level of uric acid （ 442 ± 77 mmol/L） than those without RPLS （ 350 ±88 mmol/L） （ P 〈 0. 05 ）. However no difference was observed for other indices. Conclusion Preeelampsia-eclampsia patients with RPLS have typical ehnieal and imaging findings, and the syndrome is reversible with appropriate treatment. Perhaps endothelial damage is related to the pathogenesis of RPLS. Monitoring the level of uric acid in patients with preeclampsia-eclampsia is of vital significance to discover RPLS in an early stage.

关 键 词：先兆子痫 磁共振成像 可逆性后部白质脑病综合征 

分 类 号：R742[医药卫生—神经病学与精神病学] R972.4[医药卫生—临床医学]