可逆性后部白质脑病综合征合并重度子痫前期或子痫临床分析

Clinical analysis of reversible posterior leukoencephalopathy syndrome complicated with severe preeclampsia or eclampsia

目的探讨重度子痫前期、子痫患者中可逆性后部白质脑病综合征(RPLS)的发病率,总结RPLS临床特征和妊娠结局。方法60例诊断为重度子痫前期或子痫的产妇,根据MRI结果分为RPLS组和非RPLS组,收集2组相关临床特征和妊娠结局信息,并进行回顾性分析。结果重度子痫前期、子痫产妇的RPLS发生率分别为47.06%(16/34)和46.15%(12/26)。与非RPLS组相比,RPLS组头痛(85.71%比23.81%)、重度高血压(42.86%比18.75%)的发生频率均明显增加(P<0.05)。枕顶叶是RPLS患者最常见的病变部位(89.29%)。RPLS组剖宫产率(92.86%比62.50%)、早产率(35.71%比9.38%)均高于非RPLS组(P<0.05),住院时间(13.14±3.01比5.41±2.50)、低蛋白血症发生率(21.43%比6.25%)高于非RPLS组(P<0.05)。结论重度子痫前期或子痫患者RPLS发生率高,临床症状及重度高血压对预测RPLS有帮助。RPLS影响分娩方式和妊娠结局,最常见的病变部位是枕叶和顶叶。

Objective To investigate the incidence of RPLS in patients with severe preeclampsia or eclampsia,and summarize the clinical features and pregnancy outcomes of RPLS.Methods Sixty women diagnosed with severe preeclampsia or eclampsia were divided into RPLS group and non-RPLS group according to MRI results.Information on clinical features and pregnancy outcomes was collected an were retrospectively analyzed.Results The incidence of RPLS in severe preeclampsia and eclampsia was 47.06%(16/34)and 46.15%(12/26),respectively.Compared with the non-RPLS group,the frequencices of headache(85.71%vs 23.81%)and severe hypertension(42.86%vs 18.75%)were significantly increased in the RPLS group(P<0.05).The occipito-parietal lobe(89.29%)was the most commonly involved site in patients with RPLS.The rate of cesarean section(92.86%vs 62.50%)and premature delivery(35.71%vs 9.38%)in RPLS group were higher than those in non-RPLS group(P<0.05),the length of hospital stay(13.14±3.01 vs 5.41±2.50)and the incidence of hypoproteinemia(21.43%vs 6.25%)were higher than those in non-RPLS group(P<0.05).Conclusion Patients with severe preeclampsia or eclampsia have a high incidence of RPLS,and the clinical symptoms and blood pressure are significantly elevated to predict RPLS.RPLS affects delivery mode and pregnancy outcome,and the most commonly involved sites are the occipital and parietal lobes.