儿童可逆性后部脑病综合征(PRES)临床特征和相关因素分析  

Analysis of Clinical Characteristics and Related Factors of Children with Posterior Reversible Encephalopathy Syndrome (PRES)

作　　者：刘鑫源 宋爱琴[2] 李莉[2] 吕振梅[2] 潘华[2] 刘建科[2] 

机构地区：[1]青岛大学医学部,山东 青岛 [2]青岛大学附属医院,儿童重症医学科,山东 青岛

出　　处：《临床医学进展》2023年第12期20563-20571,共9页Advances in Clinical Medicine

摘　　要：目的:探讨儿童可逆性后部脑病综合征(PRES)临床特征,并进一步分析其相关因素,为临床预防、识别和诊断PRES提供可靠依据。方法:以青岛大学附属医院儿科住院治疗儿童为研究对象,采用1:2配对病例对照研究,利用科研大数据平台调取近8年诊断PRES儿童纳入病例组,同期住院(1年内)、同性别、同科室、年龄 ± 1岁,BMI ± 0.5 kg/m2,未发生可逆性后部脑病患者,纳入对照组。并对病例组进行1年期的随访。结果:近8年共住院患儿220,723例住院儿童中,诊断为PRES共26例,男性18例(66.7%),女性9例(33.3%),发病年龄中位数为11岁(2~16岁)。所有患者均具有神经系统症状,常见的症状包括抽搐(21例,77.8%),头痛11例(42.31%),意识障碍11例(42.31%),视物模糊3例(11.1%),消化道症状3例(11.54%)。其中14例(51.8%)以抽搐为首发临床表现。全身症状发生后72小时内颅脑磁共振特征:多数为双侧对称部位受累,以顶叶、枕叶受累多见,但仍有少数病例出现脑干、延髓病变。大部分病变累及区域出现T1和T2高信号,FLAIR呈高信号或稍高信号、DWI呈等信号或高信号。单因素分析中,病例组中发病前3天出现高血压、肾脏疾病及风湿免疫性疾病、造血干细胞移植相较对照组多见(P < 0.05)。此外病例组中输注血液制品多于对照组(P < 0.05)。血液检查中,镁离子、白蛋白和血红蛋白浓度低于对照组(P < 0.05),钙离子浓度显著低于对照组(P < 0.001)。多因素条件logistic回归分析显示,高血压、低钙为PRES的独立危险因素。结论:儿童PRES均具有神经系统症状,包括抽搐、头痛、意识障碍、视力模糊,少数患者伴有消化系统症状。高血压、肾脏疾病或风湿免疫性疾病、血液制品输注与PRES具有相关性。高血压、低白蛋白血症、低钙血症是PRES的独立危险因素。Objective: To investigate the clinical features of posterior reversible encephalopathy syndrome (PRES) in children, and to further analyze its related factors, to provide a reliable basis for clinical prevention, identification, and diagnosis of PRES. Methods: A 1:2 paired case-control study was used to study children hospitalized in the Department of Pediatrics of the Affiliated Hospital of Qingdao University, and children diagnosed with PRES in the past 8 years were included in the case group by the Scientific Research Big Data Platform, and the patients who were hospitalized (within 1 year), of the same gender, in the same department, aged ±1 year, with a BMI of ±0.5 kg/m2. Patients without PRES were included in the control group. The case group was followed up for 1 year. Results: Among the 220,723 hospitalized children in the past 8 years, 26 were diagnosed with PRES, 18 (66.7%) were males and 9 (33.3%) were females, and the median age of onset was 11 years (2~16 years). All patients had neurological symptoms, including convulsions (21 cases, 77.8%), headache (11 cases, 42.31%), impaired consciousness (11 cases), blurred vision (3 cases, 11.1%), and gastrointestinal symptoms (11.54%). Among them, 14 cases (51.8%) had convulsions as the first clinical manifesta-tion. Brain MRI features within 72 hours after systemic symptoms occurred: most of the patients have bilateral symmetrical site involvement, with parietal and occipital lobe involvement being more common, but there are still a few cases with brainstem and bulbar lesions. T1 and T2 hyper-intensity occurred in most lesions, with high or slightly high intensity in FLAIR and iso- or hyperin-tensity in DWI. In univariate analysis, hypertension, renal disease, rheumatic immune disease, and hematopoietic stem cell transplantation were more common in the case group than in the control group 3 days before the onset of illness (P < 0.05). In addition, the cases of blood products trans-fused are more than the control group (P < 0.05). In the blood tests, the co

关 键 词：可逆性后部脑病综合征 儿童 临床特征 相关因素分析 病例对照研究 

分 类 号：R74[医药卫生—神经病学与精神病学]