可逆性后部脑病综合征细胞毒性水肿与血清白蛋白的关系  

The relationship between cytotoxic edema and serum albumin in patients with psterior reversible encephalopathy syndrome

作　　者：宋明亮 李瑞生[2] 高波[2] SONG Mingliang;LI Ruisheng;GAO Bo(Deapretment of Radiology,Ju County Traditional Chinese Medicine Hospital,Rizhao 276500,P.R.China;Department of Radiology,Yantai Yuhuangding Hospital,Yantai 264000,P.R.China)

机构地区：[1]山东省莒县中医医院放射科,山东日照276500 [2]山东省烟台毓璜顶医院影像科,山东烟台264000

出　　处：《医学影像学杂志》2018年第7期1061-1064,共4页Journal of Medical Imaging

摘　　要：目的本文探讨可逆性后部脑病综合征(PRES)出现细胞毒性水肿的潜在危险因素。方法将符合PRES诊断标准的79例患者纳入此研究。在FLAIR、DWI及ADC图上评估脑水肿的类型和严重程度,MRI表现与血清白蛋白之间的关系及细胞毒性水肿与脑水肿的分布和严重程度进行了比较。结果 53例患者(67.09%)表现为单纯性的血管源性水肿,26例患者(32.91%)表现为血管源性水肿合并细胞毒性水肿;合并有细胞毒性水肿的患者与单纯性血管源性水肿患者的血清白蛋白水平比较无统计学差异(P=0.983),合并有细胞毒性水肿患者与单纯性血管源性水肿患者的脑水肿评分具有显著性统计学差异(P=0.006)。结论血清白蛋白水平的增加可能加剧了脑水肿的发展,但不是脑水肿类型的决定因素。PRES出现细胞毒性水肿可能与局部脑灌注下降及小动脉病变有关。Objective Posterior reversible encephalopathy syndrome （PRES） is a clinicoradiologic syndrome with classic MR imaging predominant vasogenic edema in posterior lobes, occasionally with cytotoxic edema. It is not clear whether MRI findings correlate with the levels of serum albumin. We aim to determine the potential risk factors of developing cytotoxic edema in PRES. Methods Seventy-nine PRES cases with typical clinical symptoms and characteristic neuroimaging findings were enrolled in this study. FLAIR, DWI, and ADC maps were interpreted to evaluate the severity and type of edema. MRI findings were correlated with the levels of serum albumin, and the location and severity of brain edema were compared with cytotoxic edema. Results Among them, pure vasogenic edema was found in 53 cases （67.09%）, and vasogenic edema with cytotoxic components in 26 patients （32.91%）. No difference was tested in serum albumin levels between the patients with vasogenic edema and those with cytotoxic components （ P =0.983）. A significant difference of the edema scale scores was found between patients with pure vasogenic edema and those combined with cytotoxic components （ P =0.006）. Conclusion Serum albumin may contribute to the development of edema in PRES but is not a decisive factor for edema type. Cytotoxic edema in PRES is probably related to regional decreased perfusion and arteriolopathy.

关 键 词：可逆性后部脑病综合征 脑水肿 白蛋白 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]