Predictors of oedema type in reversible posterior leukoencephalopathy syndrome with preeclampsia or eclampsia
Predictors of oedema type in reversible posterior leukoencephalopathy syndrome with preeclampsia or eclampsia
复制标题
伴有先兆子痫或子痫的可逆性后部白质脑病综合征中水肿类型的预测因子
DOI：
10.1016/j.preghy.2017.12.011
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发表时间：
2018-01-01
影响因子：
2.2
通讯作者：
Zhang, Wei-Xi
中科院分区：
文献类型：
--
作者：
Fang, Xiao-Bo;Chen, Dun-Jin;Zhang, Wei-Xi
目的：探讨与可逆性损害和临床恢复密切相关的可逆性后部白质脑病综合征(RPLS)合并子痫前期(PE)和子痫的脑水肿类型的预测因素。方法：我们收集了2013至2017年间连续44例在PE或子痫中被诊断为RPLS的患者的数据。根据MRI结果分为血管源性水肿组(n=31)和细胞毒性水肿组(n=13)。回顾性收集一般资料、临床资料、生化指标和影像特征，探讨两组间的差异。此外，我们对潜在的预测因素进行了Logistic回归分析。结果：细胞毒性水肿组免疫疾病、死胎发生率、住院时间、血清白蛋白(ALB)、乳酸脱氢酶(LDH)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平高于血管源性水肿组(P<0.05)，而收缩压(SBP)、平均动脉压(MAP)、24小时尿蛋白定量低于血管源性水肿组(P<0.05)。经Logistic回归分析，ALB浓度与血管源性水肿密切相关，AST、ALT与细胞毒性水肿密切相关(p<；0.05)。结论：ALB、AST、ALT水平可作为预测RPLS水肿度的指标。白蛋白可能通过降低胶体渗透压与血管源性水肿有关，而AST和ALT可能通过内皮功能障碍与细胞毒性水肿有关。
Objective: To explore the predictive factors of oedema types in reversible posterior leukoencephalopathy syndrome (RPLS) with preeclampsia (PE) and eclampsia, which is closely related to reversible lesions and clinical recovery. Method: We collected data from 44 consecutive patients diagnosed with RPLS in PE or eclampsia between 2013 and 2017. All patients were classified into vasogenic oedema (n = 31) or cytotoxic oedema (n = 13) groups according to magnetic resonance imaging (MRI) results. General information, clinical data, biochemical indicators and imaging features were collected retrospectively to explore the differences between the groups. Furthermore, we analysed potential predictive factors by logistic regression. Results: The occurrence rates of immune disease and stillbirth, hospitalization time and the levels of serum albumin (ALB), lactate dehydrogenase (LDH), aspartate transaminase (AST) and alanine aminotransferase (ALT) were higher, while the values of systolic blood pressure (SBP), mean arterial pressure (MAP) and 24-h urine protein were lower in the cytotoxic oedema patients than those in the vasogenic oedema patients (p < .05). The ALB concentration was closely correlated with vasogenic oedema, while AST and ALT were closely correlated with cytotoxic oedema by logistic regression (p < .05). Conclusion: The levels of ALB, AST and ALT are potential predictors for the development of oedema in RPLS. ALB is related to vasogenic oedema by a possible mechanism of decreased colloid osmotic pressure, while AST and ALT are related to cytotoxic oedema by a possible mechanism of endothelial dysfunction.