论文部分内容阅读
目的探讨儿童造血干细胞移植(HSCT)后可逆性后部脑病综合征(PRES)的发病情况、病因、临床特点、高危因素及预后,提高对PRES的诊治水平,减少儿童HSCT后PRES的发生,降低发生神经系统永久性损害的风险。方法回顾性分析83例行HSCT治疗的患儿PRES的发病诱因、临床表现、影像学改变、实验室检查、治疗及转归。结果共7例次(8.4%)发生PRES,7例次均急性起病,抽搐7例次,意识障碍5例次,呕吐3例次,头痛、视觉异常各2例次,头晕、大小便失禁各1例次。7例次均伴有不同程度的血压升高,7例次使用细胞毒性药物,6例次伴有不同程度的移植物抗宿主病(GVHD)。经及时治疗后7例次临床症状及影像学改变均完全消失,无遗留永久性脑损害。结论 PRES是儿童HSCT的常见中枢神经系统并发症,其发病与高血压、细胞毒性药物、GVHD等多种因素有关,早期预防、早期诊断、及时合理治疗是保证其良好预后的关键。
Objective To investigate the incidence, etiology, clinical features, risk factors and prognosis of reversible posterior segment encephalopathy syndrome (PRES) after hematopoietic stem cell transplantation (HSCT) in children, to improve the diagnosis and treatment of PRES, to reduce the occurrence and decrease of PRES after HSCT Risk of permanent damage to the nervous system. Methods A retrospective analysis of 83 cases of HSCT treatment of PRES in patients with predisposing factors, clinical manifestations, imaging changes, laboratory tests, treatment and outcome. Results A total of 7 episodes (8.4%) occurred in PRES, 7 cases were acute onset, convulsions in 7 cases, disturbance of consciousness in 5 cases, vomiting in 3 cases, headache and visual abnormalities in 2 cases, dizziness, incontinence 1 case each. 7 cases were accompanied by varying degrees of elevated blood pressure, 7 cases of cytotoxic drugs, 6 cases of subacute with varying degrees of graft-versus-host disease (GVHD). After the timely treatment of 7 cases of clinical symptoms and imaging changes were completely disappeared, leaving no permanent brain damage. Conclusions PRES is a common complication of central nervous system in children with HSCT. Its incidence is related to many factors such as hypertension, cytotoxic drugs and GVHD. Early prevention, early diagnosis and proper treatment are the keys to ensure its good prognosis.