摘要：

目的 总结子痫前期合并可逆性后部脑病综合征的临床和影像学特点，并筛查其相关危险因素。 方法 共111 例子痫前期患者，记录年龄、妊娠次数、收缩压、舒张压、平均动脉压、血红蛋白、血小板计数、血清肌酐和血浆D?二聚体水平，并行头部MRI检查，单因素和多因素前进法Logistic回归分析筛查子痫前期合并可逆性后部脑病综合征相关危险因素。 结果 111 例子痫前期患者中42 例合并可逆性后部脑病综合征，Logistic回归分析显示，头痛（OR = 70.958，95%CI：6.578 ~ 765.447；P = 0.000）、视觉障碍（OR = 3.966，95%CI：1.290 ~ 12.191；P = 0.016）、收缩压（OR = 1.034，95%CI：1.006 ~ 1.064；P =0.019）、血清肌酐（OR = 1.060，95%CI：1.000 ~ 1.123；P = 0.048）是子痫前期合并可逆性后部脑病综合征的独立危险因素。MRI显示，子痫前期合并可逆性后部脑病综合征病变位于额叶17 例（40.48%）、颞叶6 例（14.29%）、顶叶32 例（76.19%）、枕叶35 例（83.33%）、脑干4 例（9.52%）、小脑7 例（16.67%）以及基底节区22 例（52.38%），呈T1WI 低信号、T2WI 和FLAIR 成像高信号、扩散加权成像（DWI）高信号、表观扩散系数（ADC）低信号。 结论 头痛和视觉障碍、收缩压、血清肌酐水平是子痫前期合并可逆性后部脑病综合征的独立危险因素，与可逆性后部脑病综合征的发病密切相关。

关键词: 先兆子痫, 后部白质脑病综合征, 磁共振成像, 危险因素

Abstract:

Objective  To analyze clinical and radiological features of preeclampsia combined with reversible posterior encephalopathy syndrome (RPES) and screen related risk factors.  Methods  Clinical data of 111 preeclampsia patients were recorded, including age, number of pregnancies, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hemoglobin, blood platelet count, serum creatinine (Cr) and plasma D?dimer. Head MRI were examined in all patients. Univariate and multivariate forward Logistic regression analysis were used to screen related risk factors of preeclampsia combined with RPES.  Results  In 111 patients, 42 were combined with RPES. Logistic regression analysis showed headache (OR = 70.958, 95%CI: 6.578-765.447; P = 0.000), visual disturbance (OR = 3.966, 95%CI: 1.290-12.191; P = 0.016), SBP (OR = 1.034, 95%CI: 1.006-1.064; P = 0.019) and serum Cr (OR = 1.060, 95%CI: 1.000-1.123; P = 0.048) were independent risk factors of preeclampsia combined with RPES. MRI showed the lesions of preeclampsia combined with RPES were located in frontal lobe (17 cases, 40.48% ), temporal lobe (6 cases, 14.29% ), parietal lobe (32 cases, 76.19% ), occipital lobe (35 cases, 83.33%), brain stem (4 cases, 9.52%), cerebellum (7 cases, 16.67%) and basal ganglia (22 cases, 52.38%). MRI showed T1WI hypointensity, T2WI and FLAIR hyperintensity, diffusion ? weighted imaging (DWI) hyperintensity and apparent diffusion coefficient (ADC) hypointensity.  Conclusions  Headache, visual disturbance, SBP and serum Cr level are independent risk factors of reeclampsia combined with RPES, which are closely related to the onset of RPES.

Key words: Pre-eclampsia, Posterior leukoencephalopathy syndrome, Magnetic resonance imaging, Risk factors