卒中后不自主情绪表达障碍亚型的临床特征比较  

Comparative study on clinical features between subtypes of poststroke involuntary emotional expression disorder

作　　者：王戈鹰[1] 滕飞[1] 张旭[2] 柳毅刚[1] 谢红妹[1] 张天宇[1] 陈玉辉[1] 刘渊华[1] 聂志余[1] 靳令经[1] 

机构地区：[1]同济大学附属同济医院神经内科,上海200065 [2]同济大学附属同济医院心身科,上海200065

出　　处：《中华行为医学与脑科学杂志》2017年第2期112-117,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金项目（81400961）;上海市普陀区人才开发专项资金项目（2014-A-21）

摘　　要：目的比较卒中后病理性哭笑（poststroke pathological laughing and crying，PSPLC）与卒中后情绪不稳（poststroke emotional lability，PSEL）两种卒中后不自主情绪表达障碍（poststroke involuntary emotional expression disorder，PSIEED）亚型的临床特征差异。方法采用Cummings诊断标准筛选2014年7月至2015年12月我院确诊为PSPLC和PSEL患者，共筛选出66例PSIEED患者，其中PSEL23例，PSPLC43例，比较两临床亚型各自的开始发作时间、发作特征、合并症及病灶分布特点。结果在卒中后急性期内PSEL开始发作的患者比率高于PSPLC（47．8％ vs 9．3％，P〈0．01），但2年内反复卒中患者PSEL的比率低于PSPLC（21.7％ vs 48．8％，P〈0．05），发作严重程度评估PSEL低于PSPLC[（19．3±2．6）vs（25．7±3．8），P〈0．01]；而PSPLC较PSEI更多合并假性球麻痹（39．5％vs 13．0％，P〈0．05）、易怒倾向（41．9％ vs 8．7％，P〈0．01）和轻度认知障碍（mild cognitive impairment，MCI）（69．8％ vs 39．1％，P〈0．05），均差异有统计学意义，两型合并卒中后抑郁状态未显示明显差异（43．5％ vs 34．9％，P〉0．05）；病灶累及部位比较，PSPLC明显较PSEL更多出现累及包括桥脑和额顶叶皮层下白质的多发病灶（95．3％ vs 52．2％，P〈0．01）。结论PSPLC和PSEL在卒中后发病开始时间、发作特征、发作严重程度、合并症及病灶累及部位均有较大差异，了解其临床特征将有助于对PSIEED亚型进行鉴别诊断。Objective To analyze the clinical difference between the patients with poststroke pathological laughing and crying（PSPLC） and the patients with poststroke emotional lability（PSEL） after stroke. Methods 66 patients with poststroke involuntary emotional expression disorder （ PSIEED ） were collected from Tongji Hospital of Tongji University from July 2014 to December 2015.The 66 cases with PSIEED were classified into 43 cases with PSPLC and 23 cases with PSEL who were diagnosed by Cummings＇ s criteria. The clinical features of PSPLC and PSEL were compared with each other.Results The higher proportion of patients suffering from PSEL developed during the acute stage of stroke than the PSPLC （47.8% vs 9.3%, P 〈0.01 ） , but the score of the PLC scale was significantly higher in the patients suffering from PSPLC than the PSEL（（25.7±3.8） vs （19.3±2.6） , P〈0.01 ） ,the higher proportion of patients suffering from PSPLC had recurrent strokes in the previous 2 years than the PSEL （48.8% vs 21.7%, P〈0.05）. There were significantly more patients in the PSPLC accompanying with pseudobulbar signs,poststroke anger proneness,MCI,respectively（41.9% vs 8.7%, P〈0.01）, （39.5% vs 13.0%, P〈0.05）, （69.8% vs 39.1%, P〈0.05） ,whereas the percentage of poststroke depression showed no significantly difference between the 2 subtypes （43.5% vs 34.9%, P〉0.05）. There was significant difference on lesion location with the patients suffering from PSPLC showed bilateral multiple lesions involving the pons and bilateral subcortical white matter of frontal lobes and parietal lobes（95.3% vs 52.2%, P〈0.01 ）. Conclusion There is significant difference in the clinical features such as the severity of symptoms in pathological emotional display, accompanying symptoms and lesion location between the PSPLC and PSEL patients.Understanding the clinical features contribute to differential diagnosis between PSPLC or PSEL.

关 键 词：不自主情绪表达障碍 病理性哭笑 情绪不稳 脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]