重度子痫前期及子痫发生可复性后部脑白质综合征的MRI特点及临床分析

Clinical and MRI Appearance of Preeclampsia-eclampsia with Posterior Reversible Encephalopathy Syndrome

目的:探讨重度子痫前期及子痫发生可复性后部脑白质综合征(posterior reversible en-cephalopathy syndrome,PRES)的磁共振成像(MRI)特点和临床特点。方法:对26例重度子痫前期患者和14例子痫患者进行脑部MRI检查,根据MRI检查结果将患者分为PRES组和对照组。并对病变的部位及病变的信号特点、临床症状、血压及实验室检查特点进行分析。结果:①MRI检查40例患者,其中MRI显示正常的患者12例(对照组),MRI显示PRES患者26例(PRES组),脑梗死患者1例、颅内静脉窦血栓患者1例;②PRES组MRI表现为皮层和皮层下病变。呈现T1W信号增强和T2W信号减弱。病变部位表现为:枕叶均受累及,其次为顶叶、额叶和颞叶,少数累及基底节和脑桥;③PRES组与对照组相比,临床症状中抽搐发生率前者高于后者;同时前者血浆尿酸水平也高于后者。结论:可复性后部脑病综合征是重度子痫前期及子痫发生脑病的主要特征性损害,推测与内皮细胞损伤有关的血脑屏障受损可能在发病中起重要作用。

Objective：To investigate the clinical parameters and appearance of magnetic resonance image （MRI） associated with the posterior reversible encephalopathy syndroma （PRES） in patients with preeclampsia-eclampsia. Methods： 26 preeclampsia and 14 eclampsia patients were examined using MRI. Patients were divided into two groups, the normal group, in which patients had normal image and the PRES group. The distribution and signal pattems of the lesions, clinical features and laboratory data were compared between the two groups. Results：① 40 patients checked by MRI, 12 patients manifested as normal image, 26 with PRES findings. One had cerebral infarction and one sinovenous thrombosis. ②The appearance of MRI associated with the PRES is cortical-subcortical lesions, which appeared hypointense on T1W and hyperintense on T2W images. All PRES cases were involved with occipital lobe, less with parietal, frontal and temporal lobe, only a few with basal ganglia and pons. ③The plasma uric acid level and frequency of convulsion in PRES group is much higher than that in control group. Conclusions; PRES is the main characteristic manifestation of preeclampsia-eclampsia. Impairment of blood-brain barrier caused by endothelial injury may play critical role in its pathogenesis.