Wijdicks E F, de Groen P C, Wiesner R H, Krom R A
Department of Neurology, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1995 May;70(5):443-6. doi: 10.4065/70.5.443.
To analyze possible causative mechanisms for intracranial hemorrhage after orthotopic liver transplantation.
We conducted a retrospective survey of medical records and a case-control comparison in patients who had undergone liver transplantation during the period 1986 through 1992.
In a group of 8 patients with intracranial hemorrhage after orthotopic liver transplantation and a control series of 207 patients who had undergone liver transplantation but did not have intracranial hemorrhage, we summarized pertinent clinical and laboratory data and statistically analyzed potential risk factors for hemorrhage.
In the eight study patients, intracerebral hematomas were located in the parietal or frontal lobe in six, the cerebellum in one, and the putamen in one. Autopsy demonstrated a Candida-associated mycotic aneurysm in one of the eight patients, and one had disseminated aspergillosis. No statistically significant differences in thrombocytopenia, hypertension, extracranial bleeding sites, or cyclosporine-related neurotoxicity were found when these patients were compared with the control series. Bacteremia or fungemia was found in five of the eight patients with intracerebral hemorrhages (62%) but in only 11% of the control group (P = 0.03; Fisher's exact test).
Overwhelming infections, thrombocytopenia, or both may have a role in intracerebral hemorrhage after liver transplantation.
分析原位肝移植术后颅内出血的可能致病机制。
我们对1986年至1992年期间接受肝移植的患者的病历进行了回顾性调查，并进行了病例对照比较。
在一组8例原位肝移植术后发生颅内出血的患者和一组207例接受了肝移植但未发生颅内出血的对照患者中，我们总结了相关的临床和实验室数据，并对出血的潜在危险因素进行了统计学分析。
在8例研究患者中，6例脑内血肿位于顶叶或额叶，1例位于小脑，1例位于壳核。尸检显示8例患者中有1例存在念珠菌相关霉菌性动脉瘤，1例有播散性曲霉菌病。将这些患者与对照组比较时，在血小板减少、高血压、颅外出血部位或环孢素相关神经毒性方面未发现统计学上的显著差异。8例脑内出血患者中有5例（62%）发现菌血症或真菌血症，而对照组中仅11%发现（P = 0.03；Fisher精确检验）。
严重感染、血小板减少或两者可能在肝移植术后颅内出血中起作用。
