成人急性髓系白血病单倍体造血干细胞移植术后可逆性后部脑病综合征的诊断及治疗(附1例分析)  

Diagnosis and treatment of posterior reversible encephalopathy syndrome after hematopoittic stem cell transplantation for adult acute myeloid leukemia:1 case report

作　　者：杜晨霄 杨栋林 孙佳丽 庞爱明 冯四洲 韩明哲 姜尔烈 DU Chenxiao;YANG Donglin;SUN Jiali;PANG Aiming;FENG Sizhou;HAN Mingzhe;JIANG Erlie(Department of Hematology,The Second Hospital of Tianjin Medical University,Tianjin 300000,China;不详)

机构地区：[1]天津医科大学第二医院血液科,天津300000 [2]中国医学科学院血液病医院(血液学研究所)

出　　处：《山东医药》2021年第27期51-54,共4页Shandong Medical Journal

基　　金：天津市自然科学基金重点项目(20JCZDJC00410)。

摘　　要：目的总结成人急性髓系白血病单倍体造血干细胞移植术后可逆性后部脑病综合征(PRES)有效的诊断方法和治疗方法。方法对1例成人急性髓系白血病单倍体造血干细胞移植后发生PRES患者的临床表现、影像学结果、治疗过程进行回顾性分析。结果该患者行单倍体造血干细胞移植时,干细胞回输早期发生严重急性移植物抗宿主病伴血压升高,后很快出现难以控制的血压升高、视野改变、抽搐及意识障碍等症状,MRI显示:双侧枕叶、左侧额顶叶、左侧基底节区异常信号,考虑PRES。除外其他神经系统疾病后诊断为PRES,经控制血压、镇静、抗癫痫,停止使用的钙调磷酸酶抑制剂(CNI)等治疗后,患者临床症状及MRI异常均快速缓解。从患者血压升高至缓解逾期7 d,随访至移植后4个月患者未有神经系统疾病表现。结论急性髓系白血病患者单倍体造血干细胞移植后出现高血压、视野改变、癫痫等神经系统异常,要考虑PRES的可能,尽早行颅脑MRI明确诊断;治疗上应减量或停用CNI,应用丙戊酸和氯硝西泮等药物抗癫痫、镇静药物减少颅脑损伤、降压药物控制血压。Objective To summarize the effective diagnosis and treatment methods of posterior reversible encepha-lopathy syndrome(PRES)after haploid hematopoietic stem cell transplantation(HSCT)of adult acute myeloid leukemia.Methods A retrospective analysis of clinical manifestations,imaging results,and treatment process of an adult patient with acute myeloid leukemia(AML)who developed PRES after allo-HSCT was performed.Results When this patient underwent allo-HSCT,severe acute graft-versus-host disease(aGVHD)with elevated blood pressure occurred in the early stage of stem cell reinfusion,and soon afterwards,symptoms such as uncontrollable elevated blood pressure,visual field changes,convulsions,and disturbance of consciousness appeared.Imaging(MRI)suggested bilateral abnormal signals in the occipital lobe,left frontal parietal lobe,and left basal ganglia area,and therefore,we considered reversible posterior encephalopathy syndrome.Except for other neurological diseases,the patient was diagnosed with PRES.After blood pres-sure control,sedation,anti-epileptic,and calcineurin inhibitor(CNI)treatment,the patient's clinical symptoms and im-aging(MRI)abnormalities were quickly relieved.From the onset of the patient's blood pressure increase to the overdue re-mission for 7 days,the patient was followed up to 4 months after the transplantation and the patient had no neurological dis-ease manifestations.Conclusion After Allo-HSCT,there are neurological abnormalities such as hypertension,visual field changes,epilepsy,etc.,the possibility of PRES should be considered,and the diagnosis of brain MRI should be con-firmed as soon as possible;as for the treatment,the dose of CNI should be reduced or stopped,and valproic acid and clon-azepam should be used,the antiepileptic drugs and sedative drugs should be used to reduce brain injury,and antihyperten-sive drugs should be used to control blood pressure.

关 键 词：脑病综合征 造血干细胞移植术并发症 后循环脑白质病 造血干细胞移植术 白血病 

分 类 号：R54[医药卫生—心血管疾病]