桥本脑病患者的临床特征和预后随访观察  

Clinical features and outcomes of patients with Hashimoto′s encephalopathy

作　　者：唐毅[1] 邢怡[1] 张津[1] 贾建平[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：《中华医学杂志》2014年第9期670-673,共4页National Medical Journal of China

基　　金：国家自然科学基金（30900478）;北京市科技新星计划（20108053）

摘　　要：目的 本研究拟分析总结桥本脑病（HE）的临床、实验室、影像学特征和预后,以期提高对本病的临床认识.方法 回顾性分析2005年1月至2011年12月于宣武医院就诊的HE患者的临床症状、实验室和影像学数据及预后.结果 共有15例患者纳入本研究,女性12例.认知功能减退（11/15）和精神症状（5/15）是最常见的症状.癫痫发作（4/15）和肌阵挛（1/15）的出现比例则低于既往研究.3例患者（3/15）的头颅MRI显示颞叶海马的异常信号,这可能与其认知功能减退相关.在接受激素治疗的10例患者中,5例患者治愈,2例患者症状改善伴有残留症状,3例患者复发或没有疗效.在未接受激素治疗的5例患者中,3例患者症状缓解,2例患者症状持续加重.结论 多数HE患者激素治疗有效,部分患者未接受激素治疗仍表现出临床缓解.考虑其可治性和早期治疗的重要性,我们建议HE应该作为中枢神经系统受累疾病的常规鉴别诊断.Objective As an ill-defined syndrome consisting of heterogeneous neurological symptoms and high serum antithyroid antibody titers, Hashimoto′s encephalopathy typically responds to steroids. More serial clinical studies are required to characterize the clinical, laboratory and imaging features and outcomes. Methods We analyzed retrospectively the clinical, laboratory, and imaging features and outcomes of 15 consecutive patients with Hashimoto′s encephalopathy diagnosed at our hospital from 2005 to 2011. Results Cognitive impairment （11/15） and psychiatric symptoms （5/15） were the most frequent manifestations. Seizure （4/15） and myoclonus （1/15） were less common than previously described. Three （3/15） patients showed abnormal signals in hippocampus or temporal lobe related to memory disorders. Among 10 patients on steroid therapy, there were recovery （n=5）, improvement with residual deficits （n=2） and relapse or no effect （n=3）. Among 5 patients on non-steroid, there were stable remission with antiepileptic drugs or general neurotrophic therapy （n=3） and continuous deterioration （n=2）. Conclusion Most patients respond well to steroids while someone improves without steroid therapy. In light of its reversible course, we recommend that Hashimoto′s encephalopathy should always be considered in the differential diagnosis while evaluating disorders of central nervous system, even disorders those without manifestations of encephalopathy.

关 键 词：桥本脑病 临床特征 抗甲状腺抗体 

分 类 号：R581.4[医药卫生—内分泌] R747.9[医药卫生—内科学]