桥本脑(脊髓)病的临床分析及治疗体会  

Clinical analysis and treatment of Hashimoto's encephalopathy and encephalomyelopathy

作　　者：姚生[1] 戚晓昆[1] 俞英欣[1] 段枫[1] 

机构地区：[1]海军总医院神经内科,100048

出　　处：《中国神经免疫学和神经病学杂志》2013年第3期164-166,171,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨桥本脑(脊髓)病的临床、影像学特点及治疗体会。方法对入住作者医院的3例桥本脑(脊髓)病患者的临床资料进行回顾性分析。结果 3例桥本脑(脊髓)病中女2例,男1例;起病年龄分别为18岁、23岁和46岁。其中桥本脑病2例,桥本脑脊髓病1例。头MRI检查3例中异常2例;甲状腺超声检查结果示异常3例;脑电图检查结果示异常3例;MRA、MRV检查结果正常3例;颅压增高3例;甲状腺功能抗体增高3例;3例均给予大剂量糖皮质激素治疗,1例并用静脉用丙种球蛋白治疗。6个月后随访复发2例,1例再次经糖皮质激素冲击治疗效果明显;另1例复发后表现为脑脊髓病变,给予糖皮质激素加用环磷酰胺治疗后病情恢复。结论桥本甲状腺炎可累及脑和脊髓,结合临床表现、影像学及甲状腺功能测定,可提高桥本脑(脊髓)病的诊断率。糖皮质激素治疗效果好,但易复发,应早期足量使用,必要时加用免疫抑制剂治疗。Objective To investigate the clinical features,imaging characteristics and treatment of Hashimoto＇ s encephalopathy and encephalomyelopathy.Methods Retrospective analysis of the clinical data of all 3 cases was adopted.Results The data of the 3 cases were collected,including 2 females,1 male.Onset ages was 8,23 and 46 years.Two cases were Hashimoto＇s encephalopathy,1 case was Hashimoto＇s encephalomyelopathy.Head MRI examination was performed in 3 cases,and was abnormal in 2 cases.Thyroid ultrasound and EEG examinations showed abnormal findings in 3 cases.MRA and MRV examinations of 3 cases were normal.Increased intracranial pressure and increased level of blood thyroid-specific antibodies were detected in all 3 cases.All patients were given high doses of glucocorticoid therapy,of which 1 cases was combined with intravenous immunoglobulin.Two cases recurred six months later,of which 1 case presented with cerebral and spinal lesions.After treated with glucocorticoid and cyclophosphamide,the patient got recovery.Conclusions Hashimoto＇s thyroiditis can lead to the dysfunction in the brain and spinal cord.Clinical manifestations,neuroimaging and thyroid function test can increase the diagnosis rate of Hashimoto＇s encephalopathy and encephalomyelopathy.Glucocorticoid treatment effect is good,but easy to relapse.Corticosteroid therapy should be used early enough,if necessary,the patients should be treated with immunosuppressants.

关 键 词：桥本病 脑病 脑脊髓病 

分 类 号：R742[医药卫生—神经病学与精神病学] R581.4[医药卫生—临床医学]