我国肝移植受者继发中枢神经系统脱髓鞘疾病回顾性分析

Retrospective analysis of central pontine and extrapontine myelinolysis after liver transplantation in China

目的探讨我国肝移植受者继发中枢神经系统脱髓鞘疾病(DDCNS)的发病情况、临床表现及影响预后的相关因素。方法利用PubMed、中国知网和万方数据库检索2000—2011年中国(不包括港澳台地区)肝移植受者继发DDCNS相关病例报道,进行回顾性分析。结果纳入2000—2011年12家移植中心发表的13篇文献,共报道44例肝移植受者继发DDCNS。围手术期低钠血症纠正过快及术前存在肝性脑病史者分别占全部病例的77.4%和45.2%,与术后神经系统症状出现时间相关(P<0.05);合并感染及肾衰竭者分别占71.0%和38.7%,与临床结局有关(P<0.05)。结论肝移植受者继发DDCNS与围手术期低钠血症纠正过快及术前存在肝性脑病有关。感染和肾衰竭等并发症影响患者预后,需要临床医师重视。

Objective To investigate the causes, clinical manifestation, treatment, and prognosis of central pontine myelinolysis （CPM） and extrapentine myelinolysis （EPM） after liver transplantation. Methods The databases of CNKI, Wanfang and PubMed were searched for 2000-2011 published articles on CPM and EPM. Data were extracted by using a standardized form and a retrospective clinical analysis was performed. Results Forty-four patients reported by 12 liver transplantation centers in China's Mainland were enrolled into this analysis. Perioperative rapid correction of sodium and preoperative history of hepatic encephalopathy accounted for 77.4% and 45.2% of the total, respectively. Both events were related to the time of symptom onset （P 〈0. 05）. Postoperative infection and renal failure were 71.0% and 38.7%, and both were associated with clinical outcomes （ P 〈 0. 05 ）. Conclusion Perioperative excessive sodium correction and preoperative hepatic encephalopathy may be causes of myelinolysis after liver transplantation. The presence of complications was associated with a poor prognosis of patients, which should be paid more attention by clinicians.