肝移植后中央桥脑和脑桥外髓鞘溶解的危险因素：一项单中心研究。

Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: a single-center study.

作者信息

Crivellin Chiara, Cagnin Annachiara, Manara Renzo, Boccagni Patrizia, Cillo Umberto, Feltracco Paolo, Barbieri Stefania, Ferrarese Alberto, Germani Giacomo, Russo Francesco Paolo, Burra Patrizia, Senzolo Marco

机构信息

1 Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy. 2 Department of Neurosciences, Sciences NPSRR, University Hospital of Padua, Padua, Italy. 3 IRCCS San Camillo Foundation, Venice, Italy. 4 Department of Neuroradiology, University of Salerno, Salerno, Italy. 5 Hepatobiliary Surgery and Liver Transplant Center, University Hospital of Padua, Padua Italy. 6 Operative Unit of Anesthesia and Intensive Care, Department of Medicine, University Hospital of Padua, Padua, Italy.

出版信息

Transplantation. 2015 Jun;99(6):1257-64. doi: 10.1097/TP.0000000000000496.

DOI:10.1097/TP.0000000000000496

PMID:25427166

Abstract

BACKGROUND

Central pontine and extrapontine myelinolysis (CPM/EPM) are severe neurologic complications after liver transplantation.

METHODS

The present work retrospectively evaluated single-center prevalence of CPM/EPM and associated risk factors: cause of liver disease, hepatic encephalopathy, preoperative, intraoperative, and perioperative blood components use, serum levels, and variation of Na, Cl, and K and immunosuppression were compared between CPM/EPM patients and control group of transplanted patients without neurologic complications.

RESULTS

Among 997 transplants, CPM/EPM were diagnosed in 11 patients (1.1%), of whom four were CPM, one was EPM, and six were associated CPM and EPM. Control group consisted of 44 transplanted patients. Central pontine and extrapontine myelinolysis patients experienced higher intraoperative and perioperative serum Na/24 hr variations compared to controls (16.69 ± 5.17 vs. 9.8 ± 3.4 mEq/L, P = 0.001). Maximum peak of intraoperative or perioperative serum Na was significantly higher in patients compared to controls (151.5 ± 3.3 vs. 140.8 ± 6.2 mEq/L, P ≤ 0.001), but no difference in preoperative serum Na was detected. Three patients presented hypernatremia as isolated risk factor.

CONCLUSION

Extrapontine myelinolysis can be found isolated or associated with CPM in up to two of three liver transplanted patients with myelinolysis. A marked variation of perioperative serum Na remains the main risk factor even in patients without preexisting hyponatremia; however, isolated hypernatremia may be solely responsible in some cases.

摘要

背景

桥脑中央髓鞘溶解症和脑桥外髓鞘溶解症（CPM/EPM）是肝移植术后严重的神经系统并发症。

方法

本研究回顾性评估了CPM/EPM的单中心患病率及相关危险因素：比较了CPM/EPM患者与无神经系统并发症的移植患者对照组之间的肝病病因、肝性脑病、术前、术中和围手术期血液成分使用情况、血清水平以及钠、氯和钾的变化及免疫抑制情况。

结果

在997例移植手术中，11例患者（1.1%）被诊断为CPM/EPM，其中4例为CPM，1例为EPM，6例为CPM合并EPM。对照组由44例移植患者组成。与对照组相比，桥脑中央髓鞘溶解症和脑桥外髓鞘溶解症患者术中及围手术期血清钠/24小时变化更高（16.69±5.17对9.8±3.4 mEq/L，P = 0.001）。患者术中或围手术期血清钠的最大峰值显著高于对照组（151.5±3.3对140.8±6.2 mEq/L，P≤0.001），但术前血清钠无差异。3例患者出现高钠血症作为独立危险因素。