可逆性后部脑病综合征MRI脑水肿与血清乳酸脱氢酶及脑钠肽的关系

Relationship between MRI cerebral edema and LDH,BNP in patients with posterior reversible encephalopathy syndrome

目的探讨可逆性后部脑病综合征(PRES)患者的MRI影像学特点,进一步分析发病时患者脑水肿程度与血清乳酸脱氢酶(LDH)、脑钠肽(BNP)的关系。方法回顾性分析17例PRES患者的临床资料及MRI影像学特征,依据FLAIR、DWI及ADC图评价患者脑水肿类型及程度,分析脑水肿评分与LDH、BNP的相关性。结果MRI显示病灶多数较对称分布在顶、枕叶白质区,少数可累及额叶、基底节区、脑干。17例患者均符合血管源性水肿,其中4例合并细胞毒性水肿。患者血清LDH水平与脑水肿评分有显著相关性(r=0.575,P<0.05),而BNP与脑水肿评分无明显相关性(P>0.05)。结论PRES特征性MRI表现为双侧顶枕叶对称性血管源性水肿,但少数也可合并细胞毒性水肿,且血清LDH水平可作为评估患者脑水肿的参考指标。

Objective To investigate the MRI features of posterior encephalopathy syndrome(PRES)and further study the re⁃lationship between degree of cerebral edema and serum lactate dehydrogenase(LDH)and brain natriuretic peptide(BNP)in patients.Methods Clinical data and MRI features of 17 patients confirmed PRES were retrospectively analyzed.The types and degrees of ce⁃rebral edema were evaluated by FLAIR,DWI and ADC map,and the correlation between cerebral edema score and LDH and BNP was analyzed.Results The lesions were symmetrically distributed in the white matter areas of the parietal lobe and occipital lobe,and a few were involved in the frontal lobe,basal ganglia,brain stem.All of the 17 patients were consistent with angiogenic edema,and 4 of them were associated with cytotoxic edema.The level of serum LDH was significantly correlated with score of brain edema(r=0.575,P<0.05),while there was no linear correlations between BNP and score of brain edema(P>0.05).Conclusion MRI characteristic findings of PRES are bilateral symmetrical angiogenic edema in the parietal lobe and occipital lobe,but a few combined with cytotoxic edema,and serum LDH level can be used as a reference index to evaluate and predict cerebral edema in patients.