桥本脑病9例临床特征分析  

Clinical features of 9 cases of Hashimoto encephalopathy

作　　者：张津[1] 张倩[1] 武力勇[1] 贾建平[1] 李存江[1] 董会卿[1] 王玉平[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国实用内科杂志》2012年第3期222-224,共3页Chinese Journal of Practical Internal Medicine

基　　金：北京市教委科技发展计划面上项目(KM200910025015)

摘　　要：目的分析总结桥本脑病的临床特征,以期提高对其的临床认识。方法回顾性分析2008年1月至2010年5月首都医科大学宣武医院及北京佑安门医院神经内科收治的9例桥本脑病的临床症状、实验室和影像学数据及治疗效果。结果本组患者发病平均年龄为(39±11)岁。最常见症状为急性、亚急性起病的认知功能损害6例(66%)、意识紊乱及嗜睡4例(44%)、癫痫发作5例(55%)和精神症状3例(33%)。7例有MRI异常,在1或多个部位出现T2高信号,受累结构包括灰质皮层、白质、基底节、脑干及胼胝体。5例出现脑电图弥漫性异常。9例均有血清抗甲状腺过氧化物酶抗体(TPO-Ab)明显增高,5例出现抗甲状腺球蛋白抗体(TG-Ab)增高。7例经甲泼尼龙治疗后好转。结论急性或亚急性起病的认知功能障碍、意识模糊及嗜睡和癫痫是桥本脑病最常见症状。MRI异常多见,但表现多样,缺乏特异性。脑电弥漫性慢波支持本病诊断。血清TPO-Ab和(或)TG-Ab的增高是诊断本病的必备条件。Objective To analyze the clinical features of Hashimoto encephalopathy （ HE ） , thereby reinforcing the under- standing in clinical practice. Methods We performed a retrospective analysis on the clinical features, laboratory findings, imaging profiles and treatment outcomes of 9 patients with HE who were admitted to the department of neurology, Xuanwu Hospital of Capital Medical University between January 2008 and May 2010. Results The average age at disease onset was （ 39 ＋ 11 ） years. Common clinical symptoms were ordered as follows ： acute and subacute cognitive impairment （ 6 cases, 66% ）,disturbance of consciousness and somnolence （4 cases,44% ）,seizures （5 cases,55% ）,and psychiatric symptoms （3 cases,33% ）. Abnormality of magnetic resonance imaging was present in 7 cases,with cortex of grey matter,white mat- ter, basal ganglion, brain stem and corpus callosum being involved, as indicated by high intensity T2 signals distributed in single or multiple areas. Other findings consisted of generalized electroencephalogram abnormality （5 cases ） , marked in- crease in serum thyroid peroxidase antibody （TPO-Ab） level （9 cases） and elevated thyroglobulin antibody （TG-Ab） level （ 5 cases）. Improvement was shown after methylprednisolone treatment in 7 cases. Conclusion Acute or subacute cognition dysfunction, confusion, drowsiness and epileptic seizures are common symptoms of HE. General magnetic resonance imaging abnormalities are nonspecific and may vary in features. Generalized slow waves in electroencephalogram are suggestive of the diagnosis of HE, to which elevated serum TPO-Ab and/or TG-Ab level is indispensible.

关 键 词：桥本脑病 抗甲状腺抗体 自身免疫性甲状腺病 

分 类 号：R743[医药卫生—神经病学与精神病学]