Azuma Junji, Nabatame Shin, Nakano Sayaka, Iwatani Yoshiko, Kitai Yukihiro, Tominaga Koji, Kagitani-Shimono Kuriko, Okinaga Takeshi, Yamamoto Takehisa, Nagai Toshisaburo, Ozono Keiichi
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Brain Dev. 2015 Feb;37(2):191-9. doi: 10.1016/j.braindev.2014.04.001. Epub 2014 Apr 28.
To determine the prognostic factors for encephalopathy with bright tree appearance (BTA) in the acute phase through retrospective case evaluation.
We recruited 10 children with encephalopathy who presented with BTA and classified them into 2 groups. Six patients with evident regression and severe psychomotor developmental delay after encephalopathy were included in the severe group, while the remaining 4 patients with mild mental retardation were included in the mild group. We retrospectively analyzed their clinical symptoms, laboratory data, and magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings.
Patients in the severe group developed subsequent complications such as epilepsy and severe motor impairment. Univariate analysis revealed that higher maximum lactate dehydrogenase (LDH) levels (p=0.055) were a weak predictor of poor outcome. Maximum creatinine levels were significantly higher (p<0.05) and minimal platelet counts were significantly lower (p<0.05) in the severe group than in the mild group. Acute renal failure was not observed in any patient throughout the study. MRS of the BTA lesion during the BTA period showed elevated lactate levels in 5 children in the severe group and 1 child in the mild group. MRI performed during the chronic phase revealed severe brain atrophy in all patients in the severe group.
Higher creatinine and LDH levels and lower platelet counts in the acute phase correlated with poor prognosis. Increased lactate levels in the BTA lesion during the BTA period on MRS may predict severe physical and mental disability.
通过回顾性病例评估确定急性期出现亮树外观（BTA）的脑病的预后因素。
我们招募了10例出现BTA的脑病患儿，并将他们分为2组。6例脑病后有明显退步和严重精神运动发育迟缓的患者被纳入重症组，其余4例轻度智力障碍患者被纳入轻症组。我们回顾性分析了他们的临床症状、实验室数据以及磁共振成像（MRI）和磁共振波谱（MRS）结果。
重症组患者随后出现癫痫和严重运动障碍等并发症。单因素分析显示，较高的最大乳酸脱氢酶（LDH）水平（p = 0.055）是预后不良的一个弱预测指标。重症组的最大肌酐水平显著更高（p < 0.05），最小血小板计数显著更低（p < 0.05）。在整个研究过程中，未观察到任何患者出现急性肾衰竭。BTA期BTA病变的MRS显示，重症组有5名儿童和轻症组有1名儿童的乳酸水平升高。慢性期进行的MRI显示，重症组所有患者均有严重脑萎缩。
急性期较高的肌酐和LDH水平以及较低的血小板计数与预后不良相关。BTA期BTA病变的MRS中乳酸水平升高可能预示严重的身心残疾。
