摘要
目的:分析并探讨钙调神经磷酸酶抑制剂(CNI)相关的后部可逆性脑病综合征(PRES)的临床特点、处理方法和预后。方法:对171例异基因造血干细胞移植术患者中发生PRES的临床资料、治疗及转归等进行分析总结。结果:5例(2.9%)在进行造血干细胞移植后合并CNI相关的PRES,年龄16～28岁,中位年龄20岁。5例均为非亲缘及亲缘非全相合移植,其中2例接受非血缘全相合移植,3例接受亲缘非全相合移植。5例的临床表现以意识障碍、抽搐为主,2例CNI浓度偏高,5例头颅MRI的T2加权像均表现为白质区多发或片状高信号病灶。出现PRES后,所有患者均停用CNI并予对症治疗。1例患者因脑出血死亡,4例患者病情缓解且无复发。结论:PRES是CNI少见的中枢神经系统并发症,及早发现,处理及时,预后较佳。
Objective： To illustrate clinical features, treatment and prognosis of CNI induced PRES. Method： Clinical data, treatment and sequelae of patients who developed PRES in 171 HSCT patients were analyzed. Re- suit： Five （2.9%） patients with hematological malignancies were diagnosed of CNI induced PRES after HSCT. The median age was 20 （ 16-28 ） years old. All 5 patients received matched unrelated or mismatched related HSCT （ two received matched unrelated HSCT, among whom 3 received mismatched related HSCT）. The common clinical manifestations were conscious disturbance and convulsion. Blood concentration of CNI were elevated in 3 patients. All patients undertook MRI which revealed patchy or muhi-areas of increased signal intensity in white matter on T2WI. All 5 patients discontinued CNI and received supportive treatment. One patient died of cerebral hemor- rhage, 4 other patients recovered and without relapse. Conclusion： PRES is an uncommon complication of CNS re- lated to CNL If it is diagnosed and treated early, the prognosis of PRES is favorable.
出处
《新医学》
2012年第12期841-845,共5页
Journal of New Medicine
关键词
钙调神经磷酸酶抑制剂
后部可逆性脑病综合征
造血干细胞移植
Calcineurin inhibitor
Posterior reversible encephalopathy syndrome
Hematopoietic stem cell transplantation
