可逆性后部脑病综合征：病因与影像学表现的关系  

Posterior reversible encephalopathy syndrome：relationships between the causes and radiologic findings

作　　者：高波[1] 吕翠[1] 霍福涛[1] 郑世财[1] 高伟[1] 

机构地区：[1]烟台毓璜顶医院影像科,山东烟台264000

出　　处：《实用放射学杂志》2011年第9期1310-1312,1320,共4页Journal of Practical Radiology

摘　　要：目的 研究不同病因引起的可逆性后部脑病综合征（PRES）的影像学表现差异,并进一步探讨其发病机制.方法 回顾性分析49例PRES患者的临床和影像学资料,按病因分为3组：子痫组（26例）,高血压组（13例）和其他组（10例）.将水肿累及的脑内部位范围按解剖分为9个区域：额叶、颞叶、顶叶、枕叶、小脑、脑干、基底节、胼胝体及深部白质,每个区域记1分;由2位神经放射医生对脑水肿程度分级独立作出评价,分别记作1、2、3、4、5分.结果 高血压组平均动脉压（MAP）与子痫组MAP无明显差 别（P＞0.05）,但均高于其他组MAP（P＜0.05）.3组之间脑水肿程度评分均无统计学显著性差异（P=0.977）,子痫组基底节的累及明显高于高血压组和其他组（P=0.002）,其他部位均无明显差异.结论 不同病因引起PRES的影像学表现无明显差异,子痫/先兆子痫患者更容易累及基底节.不同病因所致的PRES脑血管源性水肿的形成可能具有不同的发病机制.Objective To study the radiologic findings of posterior reversible encephalopathy syndrome （PRES） casued by different etiology and further to investigate its pathogenesis. Methods The clinical and radiologic data of forty-nine patients with PRES were retrospectively analyzed. All the cases were divided into three groups according to the predisposing risk factors： eclampsia group （ group A, 26 cases）, hypertension group （ group B, 13 cases ） and others group { group C, 10 cases）. The brain edema affected re- gions were defined as nine locations on the basis of brain anatomy： frontal, temporal, parietal, occipital lobe and cerebellum, brain stem,basal ganglia,corpus callosum as well as deep white matter, each region marked one point,independently marked bilaterally except of corpus callosum. Brain edema degree was independently assessed by two neuroradiologists with score from one to five respectively. Results There were no difference in mean arterial pressure（MAP） between group A and group B,both of which had higher MAPs than those of group C. No statistically significant difference in brain edema degree scores was tested between three groups（P = 0. 977 ）. In contrast to other affected regions,the basal ganglia region was more frequently involved in group A than in group B and group C（P=0. 002）. Conclusion The predisposing risk factors of PRES do not make a difference in MRI appearance except that the patients associated with preeclampsia-eclampsia may have a tendency of involving in basal ganglia. The development of vasogenic edema with different causes would be of different pathogenic mechanisms.

关 键 词：脑 可逆性后部脑病综合征 磁共振成像 发病机制 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]