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心脏移植术后的后部可逆性脑病综合征:诊断与免疫抑制治疗

Posterior Reversible Encephalopathy Syndrome after Heart Transplantation: Diagnosis and Immunosuppressive Therapy.

作者信息

Kapoor Aniruddh, Birks Emma, Lenneman Andrew, McCants Kelly

出版信息

Tex Heart Inst J. 2017 Jun 1;44(3):205-208. doi: 10.14503/THIJ-15-5007. eCollection 2017 Jun.

DOI:10.14503/THIJ-15-5007
PMID:28761402
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5505400/
Abstract

Posterior reversible encephalopathy syndrome, an infrequent neurotoxicity associated with the use of tacrolimus, was first described in 1996, as a reversible syndrome manifested by headache, altered mental function, seizures, and visual disturbances. We describe the case of a 37-year-old woman who developed neurologic symptoms consistent with encephalopathy after treatment with tacrolimus, which was prescribed to maintain immunosuppression after orthotopic heart transplantation. This report also discusses the imaging methods used in the diagnosis of posterior reversible encephalopathy and highlights the difficulty of maintaining immunosuppression and managing medication-related adverse effects, while taking into account the risk of acute rejection after transplantation.

摘要

后部可逆性脑病综合征是一种与使用他克莫司相关的罕见神经毒性,于1996年首次被描述,是一种以头痛、精神功能改变、癫痫发作和视觉障碍为表现的可逆性综合征。我们报告一例37岁女性病例,该患者在原位心脏移植后使用他克莫司维持免疫抑制治疗后出现了与脑病相符的神经症状。本报告还讨论了用于诊断后部可逆性脑病的影像学方法,并强调了在考虑移植后急性排斥风险的同时,维持免疫抑制和处理药物相关不良反应的困难。

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Posterior Reversible Encephalopathy Syndrome after Heart Transplantation: Diagnosis and Immunosuppressive Therapy.心脏移植术后的后部可逆性脑病综合征:诊断与免疫抑制治疗
Tex Heart Inst J. 2017 Jun 1;44(3):205-208. doi: 10.14503/THIJ-15-5007. eCollection 2017 Jun.
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JHLT Open. 2024 Mar 2;4:100078. doi: 10.1016/j.jhlto.2024.100078. eCollection 2024 May.
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Clin Transplant Res. 2024 Jun 30;38(2):154-162. doi: 10.4285/ctr.24.0009. Epub 2024 Jun 24.
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本文引用的文献

1
Posterior reversible encephalopathy syndrome in pediatric hematologic-oncologic disease: literature review and case presentation.小儿血液肿瘤疾病中的后部可逆性脑病综合征:文献综述与病例报告
Iran J Child Neurol. 2014 Spring;8(2):1-10.
2
Life-threatening complications of posterior reversible encephalopathy syndrome in children.儿童后可逆性脑病综合征的危及生命并发症。
Eur J Paediatr Neurol. 2014 Sep;18(5):632-40. doi: 10.1016/j.ejpn.2014.04.014. Epub 2014 Apr 25.
3
Posterior reversible encephalopathy syndrome independently associated with tacrolimus and sirolimus after multivisceral transplantation.多器官移植后,他克莫司和西罗莫司与后部可逆性脑病综合征独立相关。
Am J Transplant. 2013 Mar;13(3):808-10. doi: 10.1111/ajt.12061. Epub 2013 Jan 17.
4
Cyclosporine in transplantation - a history of converging timelines.环孢素在移植中的应用——交汇的时间线简史。
J Biol Regul Homeost Agents. 2011 Oct-Dec;25(4):493-504.
5
The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension.钙调磷酸酶抑制剂他克莫司激活肾脏钠氯共转运蛋白,导致高血压。
Nat Med. 2011 Oct 2;17(10):1304-9. doi: 10.1038/nm.2497.
6
Tacrolimus (FK506)-Associated Renal Pathology.他克莫司(FK506)相关的肾脏病理学。
Adv Anat Pathol. 1997 Jul;4(4):265-276. doi: 10.1097/00125480-199707000-00032.
7
A prospective, randomized trial of single-drug versus dual-drug immunosuppression in heart transplantation: the tacrolimus in combination, tacrolimus alone compared (TICTAC) trial.一项心脏移植中单药与双药免疫抑制的前瞻性、随机试验:他克莫司联合组、他克莫司单药组比较(TICTAC 试验)。
Circ Heart Fail. 2011 Mar;4(2):129-37. doi: 10.1161/CIRCHEARTFAILURE.110.958520. Epub 2011 Jan 7.
8
Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema.后部可逆性脑病综合征,第2部分:血管源性水肿病理生理学相关争议
AJNR Am J Neuroradiol. 2008 Jun;29(6):1043-9. doi: 10.3174/ajnr.A0929. Epub 2008 Apr 10.
9
Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome.后部可逆性脑病综合征的不同影像学表现及病变分布
AJNR Am J Neuroradiol. 2007 Aug;28(7):1320-7. doi: 10.3174/ajnr.A0549.
10
Dephosphorylation of endothelial nitric-oxide synthase by vascular endothelial growth factor. Implications for the vascular responses to cyclosporin A.血管内皮生长因子对内皮型一氧化氮合酶的去磷酸化作用。对环孢素A血管反应的影响。
J Biol Chem. 2002 Aug 16;277(33):29669-73. doi: 10.1074/jbc.M204519200. Epub 2002 Jun 5.