他克莫司致儿童可逆性后部脑病综合征2例并文献复习  

Case analysis and literature review of 2 cases of posterior reversible encephalopathy syndrome caused by tacrolimus

作　　者：朱万红 赵成广[1] 王秀丽[1] 杜悦[1] ZHU Wan-hong;ZHAO Cheng-guang;WANG Xiu-li;DU Yue(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿肾脏风湿免疫科,辽宁沈阳110004

出　　处：《实用药物与临床》2022年第4期336-340,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨儿童应用他克莫司(FK506)后诱发可逆性后部脑病综合征(PRES)的早期识别与干预。方法对本中心收治的2例服用FK506后诱发PRES患儿的临床资料进行回顾性分析,并复习相关文献。结果2例女性患儿,因患狼疮性肾炎和过敏性紫癜性肾炎常规治疗疗效欠佳加用FK506,用药后出现抽搐、意识丧失、血压升高等表现,经实验室检查及影像学分析,诊断为PRES。经过积极止抽、降颅压、控制血压、停用FK506等治疗,2例患儿症状好转,复查头颅MRI显示脑内异常信号明显吸收。结论患有肾脏疾病或自身免疫病等基础疾病的患儿,应用FK506等免疫抑制剂,一旦出现神经系统症状需警惕PRES发生,应尽早行头颅MRI检查以明确诊断,并及时予以干预。Objective To explore the early identification and intervention of posterior reversible encephalopathy syndrome(PRES)induced by tacrolimus(FK506)in children.Methods The clinical data of two pediatric patients with PRES induced by FK506 in our center were retrospectively analyzed,and the related literatures were reviewed.Results The two female pediatric patients with lupus nephritis and Henoch Schonlein purpura nephritis were griven FK506 because of the poor effect of conventional treatment.After medication,the patients had increased blood pressure,convulsions and loss of consciousness,and were diagnosed with PRES based on laboratory examination and brain MRI.The patients were treated with antihypertensive and anticonvulsant drugs and diuretics,and FK506 was stopped,then the symptoms were improved,and the MRI re-examination demonstrated significant absorption of abnormal cerebral signal.Conclusion It is necessary to be alert to PRES for pediatric patients with basic diseases such as kidney disease or autoimmune disease who were treated with FK506 once there are nervous symptoms,and the brain MRI should be performed as soon as possible to make a definite diagnosis,and the intervention should be given in time.

关 键 词：可逆性后部脑病综合征 儿童 他克莫司 

分 类 号：R969[医药卫生—药理学]