儿童可逆性后部脑病综合征(PRES)临床特征和相关因素分析

Analysis of Clinical Characteristics and Related Factors of Children with Posterior Reversible Encephalopathy Syndrome (PRES)

摘要: 目的：探讨儿童可逆性后部脑病综合征(PRES)临床特征，并进一步分析其相关因素，为临床预防、识别和诊断PRES提供可靠依据。方法：以青岛大学附属医院儿科住院治疗儿童为研究对象，采用1:2配对病例对照研究，利用科研大数据平台调取近8年诊断PRES儿童纳入病例组，同期住院(1年内)、同性别、同科室、年龄 ± 1岁，BMI ± 0.5 kg/m2，未发生可逆性后部脑病患者，纳入对照组。并对病例组进行1年期的随访。结果：近8年共住院患儿220,723例住院儿童中，诊断为PRES共26例，男性18例(66.7%)，女性9例(33.3%)，发病年龄中位数为11岁(2~16岁)。所有患者均具有神经系统症状，常见的症状包括抽搐(21例，77.8%)，头痛11例(42.31%)，意识障碍11例(42.31%)，视物模糊3例(11.1%)，消化道症状3例(11.54%)。其中14例(51.8%)以抽搐为首发临床表现。全身症状发生后72小时内颅脑磁共振特征：多数为双侧对称部位受累，以顶叶、枕叶受累多见，但仍有少数病例出现脑干、延髓病变。大部分病变累及区域出现T1和T2高信号，FLAIR呈高信号或稍高信号、DWI呈等信号或高信号。单因素分析中，病例组中发病前3天出现高血压、肾脏疾病及风湿免疫性疾病、造血干细胞移植相较对照组多见(P < 0.05)。此外病例组中输注血液制品多于对照组(P < 0.05)。血液检查中，镁离子、白蛋白和血红蛋白浓度低于对照组(P < 0.05)，钙离子浓度显著低于对照组(P < 0.001)。多因素条件logistic回归分析显示，高血压、低钙为PRES的独立危险因素。结论：儿童PRES均具有神经系统症状，包括抽搐、头痛、意识障碍、视力模糊，少数患者伴有消化系统症状。高血压、肾脏疾病或风湿免疫性疾病、血液制品输注与PRES具有相关性。高血压、低白蛋白血症、低钙血症是PRES的独立危险因素。

Abstract: Objective: To investigate the clinical features of posterior reversible encephalopathy syndrome (PRES) in children, and to further analyze its related factors, to provide a reliable basis for clinical prevention, identification, and diagnosis of PRES. Methods: A 1:2 paired case-control study was used to study children hospitalized in the Department of Pediatrics of the Affiliated Hospital of Qingdao University, and children diagnosed with PRES in the past 8 years were included in the case group by the Scientific Research Big Data Platform, and the patients who were hospitalized (within 1 year), of the same gender, in the same department, aged ±1 year, with a BMI of ±0.5 kg/m2. Patients without PRES were included in the control group. The case group was followed up for 1 year. Results: Among the 220,723 hospitalized children in the past 8 years, 26 were diagnosed with PRES, 18 (66.7%) were males and 9 (33.3%) were females, and the median age of onset was 11 years (2~16 years). All patients had neurological symptoms, including convulsions (21 cases, 77.8%), headache (11 cases, 42.31%), impaired consciousness (11 cases), blurred vision (3 cases, 11.1%), and gastrointestinal symptoms (11.54%). Among them, 14 cases (51.8%) had convulsions as the first clinical manifesta-tion. Brain MRI features within 72 hours after systemic symptoms occurred: most of the patients have bilateral symmetrical site involvement, with parietal and occipital lobe involvement being more common, but there are still a few cases with brainstem and bulbar lesions. T1 and T2 hyper-intensity occurred in most lesions, with high or slightly high intensity in FLAIR and iso- or hyperin-tensity in DWI. In univariate analysis, hypertension, renal disease, rheumatic immune disease, and hematopoietic stem cell transplantation were more common in the case group than in the control group 3 days before the onset of illness (P < 0.05). In addition, the cases of blood products trans-fused are more than the control group (P < 0.05). In the blood tests, the concentrations of magne-sium, albumin and hemoglobin were lower than those of the control group (P < 0.05), and the con-centration of calcium was significantly lower than that of the control group (P < 0.001). Multivariate conditional logistic regression analysis showed that hypertension and hypocalcemia were inde-pendent risk factors for PRES. Conclusion: Children with PRES have neurological symptoms, includ-ing convulsions, headaches, impaired consciousness, blurred vision, and digestive symptoms in a few cases. Hypertension, renal or rheumatological disorders, and blood product transfusions are associated with PRES. Hypertension, hypoalbuminemia, and hypocalcemia are independent risk factors for PRES.