基于文献复习的输血后可逆性后部脑病综合征临床特征分析OA

Objective To explore the clinical characteristics of patients with posterior reversible encephalopathy syndrome(PRES)after blood transfusion,and analyze the characteristics of changes in hemoglobin concentration among post-transfusion PRES patients with different degrees of anemia.Methods A literature search on post-transfusion PRES from January 1 st,1969 to October 31 st,2025,was conducted across the China National Knowledge Infrastructure(CNKI),Wanfang Med Online,Chinese Medical Journal Full-text Database,PubMed,Metstr,Cochrane Library,and Web of Science databases.We collected the clinical and imaging data of PRES patients reported in the literature,including age,gender,etiology of anemia,history of anemia,degree of anemia(extremely severe:hemoglobin＜40g/L;severe:hemoglobin 40-69 g/L;moderate:hemoglobin 70-99 g/L;mild:hemoglobin 100-109 g/L),volume of red blood cell transfusion,hemoglobin levels measured before and after transfusion(after the last transfusion),and types of cerebral edema(vasogenic edema,cytotoxic edema,vasogenic and cytotoxic edema),post-transfusion clinical manifestations(headache,epilepsy,elevated blood pressure,visual impairment),and white matter lesion locations(frontal lobe,parietal lobe,occipital lobe,temporal lobe).An increase in blood pressure was defined as a pre-transfusion systolic blood pressure＜140mmHg and diastolic blood pressure＜90 mmHg,and an acute transient increase in blood pressure after transfusion reaching the diagnostic criteria for hypertension(systolic blood pressure ≥ 140mmHg and[or]diastolic blood pressure ≥ 90 mmHg)or a continuous increase.A history of anemia≥6 months was defined as long-term chronic anemia.The increase in hemoglobin concentration after transfusion was the difference between the hemoglobin concentration after transfusion and that before transfusion.Results A total of 68 relevant articles were retrieved in this study,including 61 English articles and 7 Chinese articles.One conference article,26 articles with inconsistent titles and abstracts,10 articles with incomplete research index data,and 7 articles involving patients aged＜18 years were excluded.Finally,24 articles were included in this study,covering a total of 33 patients with post-transfusion PRES,including 21 English articles(30 patients)and 3 Chinese articles(3 patients).(1)Among the 33 PRES patients,there was 1 male and 32 females,aged from 18 to 88 years,with an average age of(46±16)years.There were 22 cases in the extremely severe anemia group and 11 cases in the moderately severe anemia group,and there was no patient with mild anemia.Among the causes of blood transfusion,gynecological diseases accounted for the highest proportion,reaching 51.5％(17/33),followed by blood diseases(15.2％[5/33]).The pre-transfusion hemoglobin level ranged from 14 to 92 g/L,with a median of 31(20,44)g/L.Among the clinical manifestations of post-transfusion PRES,headache accounted for the highest proportion,reaching 81.8％(27/33),followed by epilepsy(69.7％[23/33]),visual impairment(51.5％[17/33]),and elevated blood pressure(36.4％[12/33]).In terms of imaging features,32 patients had vasogenic edema,and one patient had a superposition of vasogenic edema and cytotoxic edema.The most commonly involved site of the lesion was the occipital lobe,accounting for 93.3％(28/30),followed by the parietal lobe(70.0％[21/30]),frontal lobe(43.3％[13/30]),and temporal lobe(16.7％[5/30]).Sixteen patients had a clearly recorded history of anemia for 1-120 months,with a median of 48(2,120)months.(2)Compared with the moderately severe anemia group,the proportion of gynecological disease patients among the post-transfusion PRES patients in the extremely severe anemia group was higher(68.2％[15/22]vs.2/11),the pre-transfusion hemoglobin concentration([25.32±7.35]g/L vs.[56.36±116.76]g/L)and the proportion of tumor(0 vs.3/11)were lower,and the post-transfusion hemoglobin concentration was greater([72.05±18.57]g/L vs.[47.45±16.89]g/L),and a higher proportion of patients had white matter lesions involving the parietal lobe(89.5％[17/19]vs.4/11;all P＜0.05).There were no statistically significant differences in the comparison of the remaining clinical data between the two groups(all P＞0.05).Conclusions Among patients with post-transfusion PRES,the proportion of those with anemia caused by gynecological diseases is relatively high.Headache and epilepsy frequently occur after blood transfusion,and PRES white matter lesions predominantly involve the occipital lobe.In addition,the magnitude of the increase in hemoglobin concentration after transfusion is greater in patients with extremely severe anemia compared to those with moderately severe anemia.