肝移植术后并发可逆性后部白质脑病综合征1例并文献复习

doi:10.3969/j.issn.1004-583X.2025.05.013

摘要/Abstract

摘要：

目的探讨肝移植术后并发可逆性后部白质脑病综合征(posterior reversible encephalopathy syndrome, PRES)的临床特征及诊疗策略。方法回顾性分析1例肝移植术后并发PRES患者的临床表现、影像学特征、治疗方案及预后,并复习相关文献。结果患者女,50岁,于肝移植术后出现不明原因癫痫持续状态,经临床评估及影像学检查确诊为钙调神经磷酸酶抑制剂(calcineurin inhibitor,CNI)相关PRES。通过及时调整免疫抑制方案(将CNI更换为西罗莫司),患者神经系统症状完全缓解,未遗留后遗症。结论肝移植术后PRES的发生与CNI类免疫抑制剂密切相关。早期识别、及时调整免疫抑制方案是改善预后的关键。

关键词: 可逆性后部脑病综合征, 肝移植, 免疫抑制剂

Abstract:

Objective To investigate the clinical characteristics and treatment strategies for posterior reversible encephalopathy syndrome (PRES) following liver transplantation. Methods The clinical manifestations, imaging features, treatment and prognosis of a PRES patient after liver transplantation were retrospectively analyzed, and the related literatures were reviewed. Results A 50-year-old female patient presented with unexplained status epilepticus after liver transplantation. Clinical evaluation and imaging studies confirmed the diagnosis of calcineurin inhibitor (CNI)-associated PRES. After promptly adjusting for the immunosuppressive regimen (replacing CNIs with sirolimus), the patient's neurological symptoms resolved completely without sequelae. Conclusion The occurrence of PRES after liver transplantation is closely related to CNI immunosuppressive therapy. Early recognition and timely adjustment for the immunosuppressive regimen are crucial for improving the prognosis.

Key words: posterior reversible encephalopathy syndrome, liver transplantation, immunosuppressive agents

中图分类号:

R742

王东霞, 张东, 宋世飞, 杨艺敏. 肝移植术后并发可逆性后部白质脑病综合征1例并文献复习[J]. 临床荟萃, 2025, 40(5): 454-457.

Wang Dongxia, Zhang Dong, Song Shifei, Yang Yimin. Posterior reversible encephalopathy syndrome following liver transplantation: A case report and literature review[J]. Clinical Focus, 2025, 40(5): 454-457.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.05.013

https://lchc.magtechjournal.com/CN/Y2025/V40/I5/454

图/表 1

图1 肝移植术后头颅影像学表现 a1~2.双侧额叶、左侧顶叶低密度(术后第2天头颅CT);b.双侧额颞顶枕叶均大片低密度(术后第5天头颅CT);c~e.双侧额顶枕叶、左侧颞叶皮质下脑白质条片样异常信号(术后第12天头颅磁共振成像);f1~3.双侧额颞顶枕叶大片低密度(术后第18天头颅CT);g.左侧颞枕叶脑皮层异常信号(术后3个月头颅磁共振成像);h.左侧颞枕叶脑皮层异常信号(术后5个月头颅磁共振成像)

Fig.1 Cranial imaging findings after liver transplantation a1~2.Low density in bilateral frontal lobe and left parietal lobe (brain CT on the second day after operation); (b) Large-scale low densities in the bilateral frontal, temporal, parietal and occipital lobes (brain CT on the 5th day after operation); c-e.Slice-like abnormal signals in bilateral frontal parietal occipital lobe and left temporal lobe subcortical white matter (brain magnetic resonance imaging on the 12th day after operation); f1~3.Large-scale low densities in bilateral frontotemporal parietal occipital lobes (brain CT on the 18th day after operation ); g. Abnormal signals in the left temporal occipital cortex (cranial magnetic resonance imaging 3 months after surgery); h. Abnormal signals in the left temporal occipital cortex (brain magnetic resonance imaging 5 months after surgery)

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