以痴呆和意识障碍为首发症状的桥本脑病二例并文献复习  

Hashimoto＇s encephalopathy with disturbance of consciousness and dementia as initial symptoms： report of 2 cases and literature review

作　　者：傅晓丹[1] 俞灵莺[1] 张险峰[1] 张楚[1] 

机构地区：[1]南京医科大学附属杭州医院内分泌科,310006

出　　处：《中华全科医师杂志》2016年第8期635-638,共4页Chinese Journal of General Practitioners

摘　　要：报道2例桥本脑病患者的临床资料并结合相关文献讨论。2例均为女性，分别以痴呆、意识障碍为首发症状，伴有血清抗甲状腺抗体滴度显著增高，糖皮质激素和免疫抑制剂治疗后临床症状消失。检索中国知网（CNKI）和万方医学数据库2006-2015年报道的相关病例为126例。共128例中，男性18例，男女比例为1：6，年龄16—82岁，平均51．3岁，临床表现包括认知功能障碍57例（44．5％）、癫痫49例（38．3％）、精神行为异常35例（27．3％）、卒中样发作33例（25．8％）、意识障碍31例（24．2％）、椎体外系症状26例（20．3％）等，77．2％的患者（71／92）经糖皮质激素治疗后病情缓解。提示桥本脑病是一种以神经精神症状为表现的自身免疫性疾病，伴血清抗甲状腺抗体水平升高，对糖皮质激素治疗敏感，一般预后良好。Two eases of Hashimoto＇s encephalopathy （HE） are reported and relative literature is reviewed in this article. Both cases were female, with disturbance of consciousness and dementia as initial symptoms. Marked increase of anti-thyroid antibodies was found in serum of the patients. The symptoms disappeared after steroids and maintenance therapies. A total of 126 cases of HE in Chinese literature were retrieved from 2006 to 2015 through the databases of China National Knowledge Infrastructure and Wanfang Med Online. The male/female radio was 1：6 with an average age of 51.3 years. The clinical manifestations included cognitive impairment （44.5 % ）, epilepsy （ 38.3 % ）, psychiatric disorders （ 27.3 % ）, stroke-like symptoms （25.8%）, disturbance of consciousness （24.2%）, and extrapyramidal symptoms （20.3%）. Good response to steroids was observed in 77.2% HE patients. Analysis indicates that HE is an autoimmunc disease with the presence of neurological and psychiatric manifestations, elevated titers of anti-thyroid antibodies in serum and well response to steroids, with a good prognosis.

关 键 词：脑疾病 桥本 体征和症状 

分 类 号：R581[医药卫生—内分泌] R747.9[医药卫生—内科学]