可逆性后部脑病综合征患者血压与影像学表现的关系及发病机制

Posterior reversible encephalopathy syndrome:relationship between blood pressure and radiologic findings with investigation of its pathogenesis

目的探讨可逆性后部脑病综合征(PRES)患者发病时毒性血压与脑水肿范围及水肿程度的相关性,并进一步研究其发病机制。方法回顾性分析48例PRES患者的临床和影像学资料,按患者发病时平均动脉压(MAP)水平将其分为血压正常组(7例)、血压升高组(32例)及严重高血压组(9例)三组。将水肿累及的脑内部位范围按解剖分为9个区域(额叶、颞叶、顶叶、枕叶、小脑、脑干、基底节、胼胝体及深部白质),每个区域记1分;由两位神经放射医师对脑水肿程度分级独立做出评价,分别记作1、2、3、4、5分。结果三组间脑水肿累及部位比较,差异无统计学意义(P>0.05),脑水肿程度评分亦无统计学意义(P>0.05)。所有患者脑水肿累及范围及程度评分与MAP无明显相关性(r=0.16,P=0.29)。结论 PRES患者脑血管源性水肿与血压值无直线相关性,高血压并不是导致脑水肿形成的决定性因素或必备条件。

Objective To investigate the correlation between blood pressures at toxicity and brain edema extents and degrees of posterior reversible encephalopathy syndrome（ PRES） and further discuss its pathogenesis. Methods The clinical and radiologic data of forty-eight PRES patients were retrospectively analyzed. All the cases were divided into three groups according to the levels of mean arterial pressure （ MAP） ：normotensive group （ seven patients） ,hypertensive group （ thirty-two patients） and severe hypertensive group（ nine patients）. The affected edema regions were defined as nine locations on the basis of brain anatomy：frontal,temporal,parietal,occipital lobe and cerebellum,brain stem,basal ganglia,corpus callosum as well as deep white matter,each region marked one point,independently marked bilaterally except of corpus callosum. Brain edema degrees were independently assessed by two neuroradiologists with score from one to five respectively. Results The brain edema affected regions extents and edema degree scores between three groups had no statistically significant difference （ P 〉0. 05）. No linear correlation was found between brain edema affected extent and degree scores and the levels of mean arterial pressures （ r = 0. 16,P = 0. 29 ）. Conclusions There is no linear correlation between vasogenic edema and blood pressures in PRES patients. Hypertension is not the decisive factor or prerequisite for the development of brain edema in PRES.