Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis
Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis
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DOI：
10.1046/j.1365-3156.2001.00710.x
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发表时间：
2001-05-01
影响因子：
3.3
通讯作者：
Burri, C
中科院分区：
文献类型：
--
作者：
Blum, J;Nkunku, S;Burri, C
脑病是用美拉胂醇治疗昏睡病最可怕的并发症。为了调查风险因素的存在，在一项临床试验中研究了588例接受美拉胂醇治疗的患者的脑病综合征的发生率以及不同类型脑病的发展与临床结局之间的关系。38例脑病患者根据主要临床表现分为昏迷型、惊厥型和精神病性反应型。9例患者归因于惊厥类型，定义为短暂的惊厥事件，随后为发作后阶段，无全身性疾病体征。这些患者均未死于该反应。在该组中通常未观察到反应前48小时内的发热反应。25例患者属于昏迷类型，这是一种持续数天的渐进性昏迷。这些患者通常有全身性疾病的体征，如发热（84%），头痛（72%）或大疱性皮肤反应（8%）。该组的死亡风险很高（52%）。16例昏迷型脑病综合征患者中约有14例感染疟疾。有精神病反应或精神行为异常的患者（3/38）和1例饮酒后死亡的患者被排除在分析之外。在分析的病例（n = 34）中，脑病综合征的总体发生率为5.8%，其中38.2%死亡。根据治疗开始前的症状和体征，我们没有发现任何对发生脑病综合征风险有预测价值的参数。治疗期间出现发热反应（RR 11.5）、头痛（RR 2.5）、大疱性出疹（RR 4.5）和收缩期低血压（RR 2.6）与脑病综合征（尤其是昏迷型）发生风险增加相关。
Encephalopathies are the most feared complications of sleeping sickness treatment with melarsoprol. To investigate the existence of risk factors, the incidence of encephalopathic syndromes and the relationship between the development of different types of encephalopathies and the clinical outcome was studied in a clinical trial with 588 patients under treatment with melarsoprol. The 38 encephalopathy cases were classified into three types according to the leading clinical picture: coma type, convulsion type and psychotic reactions. Nine patients were attributed to the convulsion type, defined as a transient event of short duration with convulsions followed by a post-ictal phase, without signs of a generalized disease. None of these patients died from the reaction. Febrile reactions in the 48 h preceding the reaction were generally not observed in this group. Twenty-five patients were attributed to the coma type, which is a progredient coma lasting several days. Those patients often had signs of a generalized disease such as fever (84%), headache (72%) or bullous skin (8%) reactions. The risk of mortality was high in this group (52%). About 14/16 patients with encephalopathic syndrome of the coma type were infected with malaria. Patients with psychotic reactions or abnormal psychiatric behaviour (3/38) and one patient who died after alcohol intake were excluded from the analysis. The overall rate of encephalopathic syndromes in the cases analysed (n = 34) was 5.8%, of which 38.2% died. We did not find any parameters of predictive value for the risk of developing an encephalopathic syndrome based on the symptoms and signs before treatment initiation. The appearance during treatment of febrile reactions (RR 11.5), headache (RR 2.5), bullous eruptions (RR 4.5) and systolic hypotension (RR 2.6) were associated with an increased risk for the occurrence of encephalopathic syndromes especially of the coma type.