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妊娠期急性间歇性卟啉病的治疗及产后可逆性后部脑病综合征:一例报告

Treatment of acute intermittent porphyria during pregnancy and posterior reversible encephalopathy syndrome after delivery: A case report.

作者信息

Zhang Jian, Hu Yiting, Zheng Jimin, Gao Juncha, Hou Hongtao, Liu Na, Wang Yuzhen

机构信息

Department of Gastroenterology and Hepatology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China.

出版信息

Exp Ther Med. 2017 Dec;14(6):5554-5556. doi: 10.3892/etm.2017.5212. Epub 2017 Sep 27.

Abstract

Acute intermittent porphyria (AIP) is a rare inherited disorder of heme metabolism. It has the ability to trigger posterior reversible encephalopathy syndrome (PRES), a rare acute neurologic condition that is characterized by acute neurological symptoms. Pregnancy may induce AIP attacks. The present report describes the case of a pregnant woman with AIP. The patient was treated with heme-arginate during pregnancy and successfully delivered a healthy baby. Following delivery, the patient presented with PRES and experienced generalized seizures. Treatment including arginine hemoglobin, calcium gluconate and sodium chloride was administered. The symptoms of epilepsy did not recur. Magnetic resonance imaging of the head demonstrated that the bilateral occipital lobe lesions were significantly reduced in size following the treatment. In the present report, it was demonstrated that administration of heme-arginate for AIP during pregnancy is safe. Timely administration of arginine hemoglobin, calcium gluconate and sodium chloride may more efficiently improve the clinical status in AIP patients diagnosed with PRES who experience generalized seizures.

摘要

急性间歇性卟啉病(AIP)是一种罕见的遗传性血红素代谢紊乱疾病。它能够引发可逆性后部脑病综合征(PRES),这是一种罕见的急性神经系统疾病,其特征为急性神经症状。妊娠可能诱发AIP发作。本报告描述了一名患有AIP的孕妇病例。该患者在孕期接受了精氨酸血红素治疗,并成功产下一名健康婴儿。产后,患者出现PRES并发生全身性癫痫发作。给予了包括精氨酸血红蛋白、葡萄糖酸钙和氯化钠在内的治疗。癫痫症状未再复发。头部磁共振成像显示,治疗后双侧枕叶病变大小显著减小。在本报告中,证明了孕期给予精氨酸血红素治疗AIP是安全的。及时给予精氨酸血红蛋白、葡萄糖酸钙和氯化钠可能更有效地改善被诊断为PRES并发生全身性癫痫发作的AIP患者的临床状况。

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本文引用的文献

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Anesthetic management for combined double-valve and coronary artery bypass in a patient with acute intermittent porphyria.
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Unusual manifestation of acute hepatic porphyria in pregnancy.妊娠期急性肝卟啉症的不寻常表现。
Fetal Diagn Ther. 2007;22(2):136-8. doi: 10.1159/000097113. Epub 2006 Nov 28.
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