儿童肾病合并可逆性后部脑病综合征临床分析及预后评价  

Clinical analysis and prognosis evaluation of children with kidney disease complicated with posterior reversible encephalopathy syndrome

作　　者：吴芳[1] 贾利芳[2] WU Fang;JIA Lifang(Department of Nephrology,Children's Hospital of Shanxi,Shanxi 030013,China;Department of Neurology,Children's Hospital of Shanxi,Shanxi 030013,China)

机构地区：[1]山西省儿童医院肾内科,太原030013 [2]山西省儿童医院神经内科,太原030013

出　　处：《重庆医学》2023年第7期1009-1014,共6页Chongqing medicine

基　　金：山西省卫生健康委科研课题(201301039)。

摘　　要：目的 总结分析儿童肾脏疾病合并可逆性后部脑病综合征(PRES)的临床特点,探讨其发病的危险因素。方法 回顾性分析2014年1月至2020年12月在该院肾内科住院治疗的肾脏疾病合并PRES的12例患儿临床、影像学资料,并随访其预后。结果 研究对象中男5例,女7例,年龄4~13岁,病程15 d至12年,原发病分别为肾脏疾病综合征6例,紫癜性肾炎3例,狼疮性肾炎1例,急性链球菌感染后肾小球肾炎1例,肾动脉狭窄1例。合并PRES时血压增高11例,高度水肿7例,头痛、头晕9例,视物模糊3例,黑曚3例,意识障碍1例,急性肺水肿伴呼吸衰竭1例,抽搐11例。12例患儿头颅磁共振成像(MRI)结果显示主要以顶枕叶皮质及皮质下白质受累为主,部分累及额叶、颞叶、海马、桥脑、脊髓及小脑半球,病灶呈多样性。经积极降压、脱水、镇静等对症治疗,8周内11例患儿临床症状及影像学均恢复正常,且在后期随访期间均未再出现病情复发,1例患儿自动出院后失访。结论 肾脏疾病患儿PRES的发生与高血压及激素免疫抑制剂的应用有关,头颅MRI有助于早期诊断,合理及时的治疗可明显改善预后。Objective To summarize and analyze the clinical characteristics of children with kidney disease complicated with posterior reversible encephalopathy syndrome(PRES),and explore the risk factors of its onset.Methods The clinical and imaging data of 12 children with kidney disease complicated with PRES who were hospitalized in the department of nephrology of this hospital from January 2014 to December 2020 were retrospectively analyzed,and their prognosis was followed up.Results There were 5 males and 7 females,aged from 4 to 13 years old,with a disease course of 15 days to 12 years.The primary diseases were nephrotic syndrome in 6 cases,purpura nephritis in 3 cases,lupus nephritis in 1 case,glomerulonephritis after acute streptococcal infection in 1 case,and renal artery stenosis in 1 case.When combined with PRES,there were 11 cases of high blood pressure,7 cases of high edema,9 cases of headache and dizziness,3 cases of blurred vision,3 cases of amaurosis,1 case of disturbance of consciousness,1 case of acute pulmonary edema with respiratory failure,and 11 cases of convulsions.The results of magnetic resonance imaging(MRI)of 12 cases of patients showed that the lesions were mainly involved in the parietal and occipital cortex and subcortical white matter,and partially involved in the frontal lobe,temporal lobe,hippocampus,pons,spinal cord and cerebellar hemisphere,the lesions were diverse.After symptomatic treatment such as active hypotension,dehydration,sedation,etc.,the clinical symptoms and imaging of 11 children returned to normal within 8 weeks,and there was no relapse during the follow-up period in the later stage.One child lost the follow-up after automatic discharge from the hospital.Conclusion The occurrence of PRES is related to hypertension and the use of hormone immunosuppressive agents in children with kidney disease.Brain MRI is helpful for early diagnosis,and reasonable and timely treatment can significantly improve the prognosis.

关 键 词：可逆性后部脑病综合征 儿童 肾病 磁共振成像 血管源性脑水肿 

分 类 号：R726.9[医药卫生—儿科]