重度子痫前期与子痫并发可逆性后部白质脑病综合征31例临床分析

Severe pre-eclampsia and eclampsia complicated with reversible posterior leukoencephalopathy syndrome： analysis of 31 cases

目的探讨重度子痫前期、子痫并发可逆性后部自质脑病综合征（RPLS）的临床特点。方法回顾性分析31例重度子痫前期、子痫并发RPLS患者的临床资料。结果31例RPLS占同期发生的64例子痫患者的48％。31例均有高血压、头痛、视力障碍，血压最高210／140mmHg（1mm Hg=0.133kPa），24例子痫发作；19例恶心、呕吐；13例在子痫发作后持续烦躁；影像学检查示以大脑后部白质为主的水肿区，特别是枕叶，CT检查示枕顶叶低密度影，MRI检查示枕顶叶长T1、长12信号。结论重度子痫前期、子痫易并发可逆性后部白质脑病综合征，血压过高、头痛、视力障碍、子痫反复发作是RPLS的主要临床表现。

Objective To explore clinical characteristics of severe pre-eclampsia and eclampsia complicated with reversible posterior leukoencephalopathy syndrome （RPLS）. Methods Clinical data of 31 cases of severe pre-eclampsia and eclampsia complicated with RPLS were studied retrospectively. Results These 31 cases with RPLS accounted for 48% of those with eclampsia, and all presented with hypertension, headache and disturbance of vision, 24 cases with seizure episodes, 19 cases with nausea and vomiting and 13 with continuous dysphoria after seizure. Neuroradiologic findings showed edema predominantly in the bilateral posterior cerebral white matter, especially in occipital-parietal lobe, with low density lesions in CT and long T1 and T2 signals in brain MRI. Conclusions Severe pre-eclampsia and eelampsia tended to complicate with RPLS, presenting severe hypertension, headache, disturbance of vision and recurrent seizure as major clinical manifestations.