迟发性运动障碍的临床诊治进展  

Clinical Diagnosis and Treatment of Tardive Dyskinesia

作　　者：王喜喜 万新华[1] WANG Xixi;WAN Xinhua(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院神经科,北京100730

出　　处：《协和医学杂志》2022年第4期644-651,共8页Medical Journal of Peking Union Medical College Hospital

基　　金：国家自然科学基金(81971074)。

摘　　要：迟发性运动障碍(tardive dyskinesia,TD)是与长期服用多巴胺受体阻滞剂相关的一种异常不自主运动,可累及面颈部,引起伸舌、咀嚼、噘嘴、歪颌或转颈,也可累及四肢和躯干,表现为舞蹈样动作。临床上最常见的病因为抗精神病药物(antipsychotic drug,APD)的使用。与TD相关的危险因素包括APD的种类、用药剂量和时间、年龄和性别,遗传因素也发挥一定作用。目前研究较多的TD相关基因为CYP2D6、DRD2、DRD3、HTR2A、HTR2C、VMAT2、MnSOD、HSPG2。TD的发病机制尚不明确,主要有多巴胺受体超敏学说、氧化应激学说和突触可塑性失调学说。临床上治疗TD较为困难,预防至关重要。本文就TD的临床诊治进展进行综述,以进一步加深医务人员对该疾病的认识。Tardive dyskinesia(TD)is a kind of disabling movement disorder characterized by involuntary movements of the face,neck,extremities or trunk that results from long-term use of dopamine receptor blocking agents.The most common reason is the use of antipsychotic drug(APD).Identified risk factors include the type,dose,as well as the duration of APD.Age,sex,genetics also play a role.CYP2D6,DRD2,DRD3,HTR2A,HTR2C,VMAT2,MnSOD,HSPG2 gene may be involved.The pathogenesis is not clear.Three hypotheses are proposed:dopamine receptor super-sensitivity,oxidative stress and maladaptive synaptic plasticity.TD is quite hard to cure,prevention is of vital importance.This article reviews the clinical diagnosis and treatment of TD,so as to further deepen medical staff's understanding of TD.

关 键 词：迟发性运动障碍 多巴胺受体阻滞剂 抗精神病药物 囊泡单胺转运体2抑制剂 

分 类 号：R746[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学]