Fang X B, Chen D J, He F, Su C H, Ren L W, Chen J, Liang Y L
Department of Neurology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Jan 25;52(1):40-46. doi: 10.3760/cma.j.issn.0529-567X.2017.01.009.
To investigate the risk factors of reversible posterior leukoencephalopathy syndrome (RPLS) in pre-eclampsia or eclampsia gravida. This study was conducted in the Third Affiliated Hospital of Guangzhou Medical University between January 2013 and March 2016. A total of 100 patients who had no severe neurological diseases and were diagnosed pre-eclampsia or eclampsia, and underwent brain MRI were collected retrospectively. They were divided into 2 groups according to the MRI results, the RPLS group (49) and the non-RPLS group (51). The medical history, clinical symptoms and the results of laboratory examination were analyzed by the logistic regression, in order to explore the risk factors. In single factor analysis, HELLP syndrome, pregnancy associated with other diseases, poor prenatal care, grade 3 hypertension, elevated systolic blood pressure or diastolic blood pressure, elevated WBC, aspartate transaminase (AST), alanine aminotransferase (ALT), uric acid (UA) and lactate dehydrogenase (LDH), decreased platelet (PLT), headache, visual changes, seizures and conscious disturbance were more frequent in the RPLS group than those in the non-RPLS group (all 0.05). According to the multivariate logistic regression analysis, the elevated WBC (1.291, 95% : 1.058-1.575, 0.012), UA (1.008, 95% : 1.001-1.016, 0.032) and headache (18.260, 95% : 3.562-93.607, 0.000) were the independent risk factors. Maternal history, clinical symptoms and some laboratory examinations might help in the early diagnosis of RPLS in pre-eclampsia or eclampsia gravida. Headache, the elevation of WBC and UA were the most significant factors.
探讨子痫前期或子痫孕妇发生可逆性后部白质脑病综合征(RPLS)的危险因素。本研究于2013年1月至2016年3月在广州医科大学附属第三医院进行。回顾性收集100例无严重神经系统疾病、诊断为子痫前期或子痫且接受脑部MRI检查的患者。根据MRI结果将其分为2组,RPLS组(49例)和非RPLS组(51例)。采用逻辑回归分析病史、临床症状及实验室检查结果,以探讨危险因素。单因素分析显示,RPLS组HELLP综合征、合并其他疾病的妊娠、产前检查差、3级高血压、收缩压或舒张压升高、白细胞(WBC)升高、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、尿酸(UA)和乳酸脱氢酶(LDH)升高、血小板(PLT)降低、头痛、视觉改变、癫痫发作及意识障碍的发生率均高于非RPLS组(均P<0.05)。多因素逻辑回归分析显示,WBC升高(1.291,95%可信区间:1.058 - 1.575,P = 0.012)、UA升高(1.008,95%可信区间:1.001 - 1.016,P = 0.032)和头痛(18.260,95%可信区间:3.562 - 93.607,P = 0.000)是独立危险因素。孕妇病史、临床症状及一些实验室检查有助于子痫前期或子痫孕妇RPLS的早期诊断。头痛、WBC及UA升高是最显著的因素。