路易体痴呆26例临床分析  

Clinical analysis of 26 cases of dementia with Lewy bodies

作　　者：王超伟[1] 吉四辈[1] 刘艳霞[1] 袁彬[1] 赵建华[1] 王朔 随瑞斌 WANG Chaowei;JI Sibei;LIU Yanxia(The First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院神经内科,河南新乡453100

出　　处：《中风与神经疾病杂志》2020年第10期924-926,共3页Journal of Apoplexy and Nervous Diseases

基　　金：河南省政府自然科学基金(182300410389);河南省医学科技攻关计划项目(201303105)。

摘　　要：目的总结路易体痴呆(dementia with Lewy bodies,DLB)的临床特征及神经影像学特点。方法收集2012年2月-2018年11月于新乡医学院第一附属医院诊治的26例“可能的”或“很可能的”DLB患者的临床资料进行回顾性分析。结果本组患者男19例,女7例,平均发病年龄(66.73±7.58)岁。以认知症状为首发者占65%,帕金森样症状首发者占19%,38%的患者认知障碍波动明显,77%的患者出现帕金森样症状,62%的患者出现幻觉,50%的患者出现快速眼球运动期睡眠行为障碍,65%的患者伴随自主神经功能障碍。59%(13/22)患者的头部核磁检查显示海马结构无萎缩或轻度萎缩,7例患者的18F-FDG PET检查均表现为以双侧顶枕叶为著的脑代谢减低模式,2例患者的11C-CFT PET检查均表现为双侧基底节转运体摄取减低。结论DLB多数以认知症状起病者,帕金森样症状、幻觉、快速眼动期行为障碍和精神症状是其主要表现,神经影像学检查有助于DLB的临床诊断。Objective To investigate the clinical and neuroimaging features of dementia with Lewy bodies(DLB).Methods The clinical data of 26 patients with DLB were retrospectively analyzed.Results The initial symptoms were cognitive symptoms(65%),Parkinsonism(19%),or both.In the clinical manifestations,38%of patients showed fluctuating cognition,77%showed Parkinsonism,62%showed hallucinations,and 50%showed rapid eye movement sleep behavior disorder,65%showed severe autonomic dysfunction.59%of the patients revealed the preservation of hippocampal structures on MRI scan.In addition,FDG PET showed hypo-metabolism in bilateral parietal and occipital lobe in 7 patients,and CFT PET demonstrated reduced dopamine transporter uptake in the basal ganglia in 2 patients.Conclusion Cognitive impairment was the initial symptoms in most patients with DLB,and the clinical symptoms were characterized by Parkinsonism,hallucinations,rapid eye movement sleep behavior disorder and psychiatric symptoms.Neuroimaging examination including MRI and PET scan were useful to diagnose.

关 键 词：LEWY体病 痴呆 磁共振成像 正电子发射断层显像术 

分 类 号：R749.1[医药卫生—神经病学与精神病学]