Hu Hongtao, Xu Shen, Hu Shuang, Xu Weijia, Shui Hua
Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.
Department of Nephrology, Taihe Hospital, Shiyan, Hubei 442000, P.R. China.
Exp Ther Med. 2017 Jul;14(1):881-887. doi: 10.3892/etm.2017.4570. Epub 2017 Jun 8.
Few studies have investigated posterior reversible encephalopathy syndrome (PRES) in patients with chronic renal failure (CRF). The present study analyzed the clinical manifestations, laboratory examinations and imaging features of PRES in patients with CRF. A total of 42 patients with CRF with or without PRES were recruited in the current retrospective case-control study. Patient data taken prior to the onset of PRES in patients with CRF and PRES (n=21) were collected and analyzed. At the same time, data from patients with CRF but without PRES (n=21) were also analyzed. Brain magnetic resonance imaging (MRI) scans were collected from patients in the PRES group. The mean blood pressure of patients in the PRES group was significantly higher than that of the control group (systolic blood pressure: 172±15 mmHg vs. 135±14 mmHg, P<0.01; diastolic blood pressure: 95±16 mmHg vs. 64±13 mmHg, P<0.01). Furthermore, compared with the control group, mean serum albumin (Alb) and hemoglobin (Hb) concentrations in the PRES group were significantly lower (Alb: 29.1±5.3 g/l vs. 34.6±6.1 g/l, P=0.001; Hb: 74±16 g/l vs. 89±28 g/l, P=0.037). By contrast, mean LDH concentration was significantly higher in the PRES group (LDH: 336±141 U/l vs. 235±89 U/l, P=0.004). In the PRES group, 24 h urine volume was significantly lower in the PRES group than in the control group (24 h urine volume: 651±520 ml vs. 982±518 ml, P=0.046). No significant differences in levels of serum potassium (4.5±0.6 mmol/l vs. 4.4±0.5 mmol/l, P=0.377), sodium (138.3±4.9 mmol/l vs. 139.0±6.8 mmol/l, P=0.325), calcium (2.0±0.24 mmol/l vs. 1.9±0.24 mmol/l, P=0.673), alanine aminotransferase; (24±14 U/l vs. 18±8 U/l, P=0.975); aspartate aminotransferase (29±11 U/l vs. 24±9 U/l, P=0.619) and uric acid (448±148 µmol/l vs. 378±116 µmol/l, P=0.599) were found between the two groups. PRES is a relatively common nervous system complication arising in patients with CRF. Certain biochemical markers, including Hb and Alb, may be associated with PRES. Diagnosing PRES is difficult as computed tomography (CT) brain scans may be normal and MRI scans, which are more sensitive than CT scans at diagnosing PRES, are not always performed in patients with CRF. Thus, brain MRI scans should be taken first in such patients when PRES is suspected.
很少有研究调查慢性肾衰竭（CRF）患者的后部可逆性脑病综合征（PRES）。本研究分析了CRF患者PRES的临床表现、实验室检查和影像学特征。在当前这项回顾性病例对照研究中，共纳入了42例患有或未患有PRES的CRF患者。收集并分析了CRF合并PRES患者（n = 21）在PRES发作前的患者数据。同时，也分析了CRF但未患PRES患者（n = 21）的数据。收集了PRES组患者的脑磁共振成像（MRI）扫描结果。PRES组患者的平均血压显著高于对照组（收缩压：172±15 mmHg对135±14 mmHg，P<0.01；舒张压：95±16 mmHg对64±13 mmHg，P<0.01）。此外，与对照组相比，PRES组患者的平均血清白蛋白（Alb）和血红蛋白（Hb）浓度显著更低（Alb：29.1±5.3 g/l对34.6±6.1 g/l，P = 0.001；Hb：74±16 g/l对89±28 g/l，P = 0.037）。相比之下，PRES组患者的平均乳酸脱氢酶（LDH）浓度显著更高（LDH：336±141 U/l对235±89 U/l，P = 0.004）。PRES组患者的24小时尿量显著低于对照组（24小时尿量：651±520 ml对982±518 ml，P = 0.046）。两组患者的血清钾（4.5±0.6 mmol/l对4.4±0.5 mmol/l，P = 0.377）、钠（138.3±4.9 mmol/l对139.0±6.8 mmol/l，P = 0.325）、钙（2.0±0.24 mmol/l对1.9±0.24 mmol/l，P = 0.673）、丙氨酸转氨酶（24±14 U/l对18±8 U/l，P = 0.975）、天冬氨酸转氨酶（29±11 U/l对24±9 U/l，P = 0.619）和尿酸（448±148 µmol/l对378±116 µmol/l，P = 0.599）水平均无显著差异。PRES是CRF患者中相对常见的神经系统并发症。某些生化指标，包括Hb和Alb，可能与PRES有关。由于脑部计算机断层扫描（CT）可能正常，而在CRF患者中并不总是进行比CT扫描对PRES诊断更敏感的MRI扫描，因此诊断PRES存在困难。因此，当怀疑此类患者患有PRES时，应首先进行脑部MRI扫描。
