重度子痫前期或子痫孕妇合并可逆性后部白质脑病综合征的危险因素分析

摘要

Objective To investigate the risk factors of reversible posterior leukoencephalopathy syndrome (RPLS) in pre-eclampsia or eclampsia gravida. Methods This study was conducted in the Third Affiliated Hospital of Guangzhou Medical University between January 2013 and March 2016. A total of 100 patients who had no severe neurological diseases and were diagnosed pre-eclampsia or eclampsia, and underwent brain MRI were collected retrospectively. They were divided into 2 groups according to the MRI results, the RPLS group (n=49) and the non-RPLS group (n=51). The medical history, clinical symptoms and the results of laboratory examination were analyzed by the logistic regression, in order to explore the risk factors.Results In single factor analysis, HELLP syndrome, pregnancy associated with other diseases, poor prenatal care, grade 3 hypertension, elevated systolic blood pressure or diastolic blood pressure, elevated WBC, aspartate transaminase (AST), alanine aminotransferase (ALT), uric acid (UA) and lactate dehydrogenase (LDH), decreased platelet (PLT), headache, visual changes, seizures and conscious disturbance were more frequent in the RPLS group than those in the non-RPLS group (all P<0.05). According to the multivariate logistic regression analysis, the elevated WBC (OR=1.291, 95%CI:1.058-1.575, P=0.012), UA (OR=1.008,95%CI:1.001-1.016,P=0.032) and headache (OR=18.260, 95%CI:3.562- 93.607, P=0.000) were the independent risk factors.Conclusions Maternal history, clinical symptoms and some laboratory examinations might help in the early diagnosis of RPLS in pre-eclampsia or eclampsia gravida. Headache, the elevation of WBC and UA were the most significant factors.%目的：探讨重度子痫前期或子痫孕妇合并可逆性后部白质脑病综合征（RPLS）的危险因素。方法收集2013年1月至2016年3月于广州医科大学附属第三医院诊断为重度子痫前期或子痫并行头颅MRI筛查的孕妇100例，根据影像学检查结果分为合并RPLS组（49例）和未合并RPLS组（51例）。对两组孕妇的一般临床资料、入院时的血压和症状、实验室检查结果分别进行比较，并通过多因素logistic回归分析重度子痫前期或子痫孕妇合并RPLS的危险因素。结果单因素分析结果显示，合并RPLS组孕妇中合并HELLP综合征，合并其他疾病，未规律产前检查，高血压3级，收缩压或舒张压升高，WBC、天冬氨酸转氨酶、丙氨酸转氨酶、尿酸和乳酸脱氢酶水平升高，血小板计数减少，出现头痛、视物模糊、痫样发作和精神或意识障碍者均较未合并RPLS组多（P均<0.05）。多因素logistic回归分析显示，WBC升高（OR=1.291，95%CI为1.058～1.575，P=0.012）、尿酸水平升高（OR=1.008，95%CI为1.001～1.016，P=0.032）和出现头痛症状（OR=18.260，95%CI为3.562～93.607，P=0.000）是重度子痫前期或子痫孕妇合并RPLS的独立危险因素。结论重度子痫前期或子痫孕妇的病史、临床症状、体征及实验室检查有助于早期识别RPLS，其中头痛和WBC、尿酸水平的升高在重度子痫前期或子痫孕妇合并RPLS中有一定的预测作用。