可逆性后部脑病综合征患者血清乳酸脱氢酶与MRI表现的关系

Correlation Between Serum Lactate Dehydrogenase and MRI Features in Patients with Posterior Reversible Encephalopathy Syndrome

目的探讨可逆性后部脑病综合征(PRES)患者血清乳酸脱氢酶(LDH)与MRI表现(脑水肿程度、类型)的关系。资料与方法纳入有典型临床症状和MRI表现的35例PRES患者,由2位神经放射医师评价脑水肿程度,综合分析液体衰减反转恢复(FLAIR)像、扩散加权成像(DWI)和表观扩散系数(ADC)图,判断水肿类型,分析脑水肿程度及类型与LDH水平的相关性。结果子痫患者LDH水平([536.9±252.4)IU/L]显著高于非子痫患者[340.7±117.4)IU/L(]P<0.05)。有脑深部结构累及的患者LDH水平[(492.4±215.9)IU/L]显著高于无脑深部结构累及的患者([355.7±205.8)IU/L)](P<0.05)。有、无细胞毒性水肿患者之间血清LDH水平[(522.0±241.5)IU/L(、388.0±191.2)IU/L]差异无统计学意义(P>0.05)。LDH水平与脑水肿分布评分呈中度正相关(r=0.65,P<0.01)。结论脑水肿程度可能反映患者炎症的严重程度,血清LDH水平可作为PRES患者脑水肿程度的预测指标。

Purpose To determine the relationship between MRI features （degree and type of edema） of posterior reversible encephalopathy syndrome （PP, ES） and level of serum lactate dehydrogenase （LDH）. Material and Methods Thirty-five patients with typical clinical symptoms and characteristic MRI findings of PRES were included in this study. The extent and distribution of brain edema were graded by two observers blinded to patients＇ clinical information. The level of serum LDH was correlated with the degree and type of edema determined on FLAIR, DWI and ADC map. Results There were statistical significances of serum LDH level between eclamptic and non-eclamptic patients [（536.9±252.4） IU/L vs. （340.7±117.4） IU/L, P〈0.05], and between patients with and without deep structures involved [（492.4±215.9） IU/L vs. （355.7±205.8） I U/L, P〈0.05]. Serum LDH level of patients with cytotoxic or vasogenic edema showed no statistical difference [（522.0±241.5） IU/L vs. （388.0 ±191.2） I U/L, P〉0.05]. The level of serum LDH was significantly correlated with brain edema （r=0.65, P〈0.01）. Conclusion Increased serum LDH level, which plays an essential role in endothelial injury, may be a potential risk factor for the development of edema in PRES.