Reversible Leukoencephalopathy Syndrome Associated to Leukopenia in a Chronic Hemodialysis Patient
Reversible Leukoencephalopathy Syndrome Associated to Leukopenia in a Chronic Hemodialysis Patient
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慢性血液透析患者中与白细胞减少相关的可逆性白细胞脑病综合征
DOI：
10.1111/j.1774-9987.2005.00207.x
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发表时间：
2005
影响因子：
1.9
通讯作者：
Rafael García
中科院分区：
文献类型：
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作者：
O. Salgado;B. Rosales;Rafael García
摘要： 可逆性白质脑病综合征是一种罕见的以脑白质弥漫性衰减为特征的疾病，常见于接受钙调神经磷酸酶抑制剂的移植患者或患有严重高血压的患者。我们报告一位22岁男性慢性血液透析患者，患有控制良好的中度高血压，表现为新发头痛和全身性癫痫。头颅磁共振成像(MRI)在T2加权图像上显示白质中多个区域信号强度增加，在随后的MRI中自发分解。流式细胞仪显示白细胞计数呈白细胞减少，而CD4计数正常。无法证明病毒病原学。可逆性白质脑病综合征症状在72 h内缓解，但白细胞减少持续10 月以上。患者在RLS发病15个 月后接受了肾移植，并从移植后第二天开始接受环孢素A治疗。未观察到RLS症状复发。在本病例中，MRI改变的原因似乎既不是血管生成的，也不是细胞毒性的。
Abstract: Reversible leukoencephalopathy syndrome (RLS) is a rare brain disorder, characterized by diffuse attenuation of cerebral white matter, which has been most commonly observed in transplant patients receiving calcineurin inhibitors or in patients with severe hypertension. We report an episode of RLS in a 22‐year‐old male patient on chronic hemodialysis with well‐controlled moderate hypertension who presented with de novo headache and generalized seizures. Cranial magnetic resonance image (MRI) revealed multiple areas of increased signal intensity in the white matter on T2‐weighed images which resolved spontaneously at subsequent MRIs. White blood cell count showed leucopenia with normal CD4 count at flow cytometry. A viral etiology could not be demonstrated. Reversible leukoencephaolopathy syndrome symptoms remitted within 72 h but leukopenia persisted over 10 months. The patient received a kidney transplant 15 months after RLS onset and has received cyclosporine since the second post‐transplant day. No recurrence of RLS symptoms has been observed. The etiology of the MRI changes in the present case seemed not to be either vasogenic or cytotoxic.
(7) 清水谷聪，“重新设计社会保障体系的“世界标准”数据的准备”，日本经济新闻，2007年3月16日。
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