非酮症性高血糖合并舞蹈症的临床及影像学相关因素  

Clinical and imaging relationship of chorea associated with non-ketotic hyperglycemia

作　　者：屈剑锋 胡慧红 林晓云 成蔚阳 陈仰昆 QU Jianfeng;HU Huihong;LIN Xiaoyun;CHENG Weiyang;CHEN Yangkun(Dongguan Hospital Affiliated to Southern Medical University,Dongguan 523000,China;Nancheng Community Health Service Center,Dongguan 523000,China)

机构地区：[1]南方医科大学附属东莞医院(东莞市人民医院),广东东莞523000 [2]东莞市南城社区卫生服务中心,广东东莞523000

出　　处：《中国实用神经疾病杂志》2023年第3期328-333,共6页Chinese Journal of Practical Nervous Diseases

基　　金：东莞市科技特派员项目(编号:20201800500542)。

摘　　要：目的探讨非酮症性高血糖合并舞蹈症合并颅脑MRI-T1高信号综合征(C-H-BG)的临床及影像学相关因素。方法本研究回顾性纳入17例在2010-01—2020-01诊断为C-H-BG患者为试验组;采用病例对照研究,依照纳排标准,根据试验组患者的年龄(±2岁)、性别、住院时间(±1月)按1∶3匹配51例同期非C-H-BG的糖尿病患者。收集所有患者的临床及影像学资料,并进行对比,分析与C-H-BG相关的危险因素。结果试验组中男8例,女9例,年龄(69±16.1)岁。与匹配组患者相比,C-H-BG组有更多的患者入院前无规律使用药物治疗(76.5%vs 25.3%,P=0.003),入院后首次静脉血糖更高[22.7(11.5~20)vs 11(7.7~14),P<0.001]和更高的糖化血红蛋白[(13.5±2.6)%vs(8±2.1)%,P<0.001)]。在影像学因素分析方面,C-H-BG组患者更常出现基底节区异常,CT上高密度灶,T1序列高信号灶,以及SWI序列低信号灶。尽管2组患者的MCA和ICA狭窄情况无统计学差异,然而CT或MRI存在基底节异常病灶的C-H-BG患者,合并对应MCA狭窄的情况显著高于匹配组,分别为:CT-对应MCA狭窄,29.4%vs 3.9%,P=0.009;MRI/T1-对应MCA狭窄,35.3%vs 0,P<0.001,MRI/SWI-对应MCA狭窄,35.3%vs 9.8%,P=0.013。Logistic回归方程分析发现,糖化血红蛋白为C-H-BG的预测因素,比值比(OR值)为1.787(95%可信区间:1.215~2.629),方程的拟合系数为0.724。结论C-H-BG患者常常出现单侧/双侧基底节区病灶,表现为CT上高密度,MRI-T1序列高信号及SWI序列低信号;本研究发现CT/MRI病灶对应侧的MCA更可能同时合并狭窄;经纠正混杂因素,糖化血红蛋白为C-H-BG的危险因素。Objective To investigate the clinical and neuroimaging indicators of chorea associated with non-ketotic hyperglycemia and high signal intensity lesions on T1-weighted brain magnetic resonance images(C-HBG).Methods Seventeen patients diagnosed as C-H-BG from January 2010 to January 2020 were included in this study retrospectively.A case-control study was conducted to match 51 non-C-H-BG diabetic patients in the same period at a ratio of 1∶3 according to the age(±2 years),sex and admission time(±1 month).The clinical and im⁃aging data of all patients were collected and compared,and the risk factors related to C-H-BG were analyzed.Re⁃sults There were 8 men and 9 women were diagnosed as C-H-BG with an average age of 69±16.1 years.Compared with the matched group,more patients in C-H-BG group used drugs irregularly before admission(76.5%vs 25.3%,P=0.003),and their first venous blood glucose after admission[22.7(11.5-20)vs 11(7.7-14),P<0.001]and glycosylated hemoglobin[(13.5±2.6%vs(8±2.1)%,P<0.001)]were higher.At the mean time,pa⁃tients in C-H-BG group were more likely to have basal ganglia lesions presented as hyperintensities lesions on CT,hyperintensities lesions on T1 sequence and hypointensities lesions on SWI sequence.Although there is no statistical difference in MCA and ICA stenosis between the two groups,the incidence of MCA stenosis in C-H-BG patients with abnormal basal ganglia lesions in CT or MRI is significantly higher than that in the matched group,CT-MCA stenosis,29.4%vs 3.9%,P=0.009;MRI/T1-corresponds to MCA stenosis,35.3%vs 0,P<0.001;MRI/SWI-corresponds to MCA stenosis,35.3%vs 9.8%,P=0.013,respectively.Logistic equation analysis showed that glycosylated hemoglobin was a predictor of C-H-BG,with an OR value was 1.787(95%CI 1.215-2.629),and the fitting coefficient of the equation was 0.724.Conclusion Patients with C-H-BG often have uni⁃lateral/bilateral basal ganglia lesions,which are characterized by hyperintensities lesions on CT,hyperintensities lesions on MRI-T1 sequence and hypointens

关 键 词：非酮症性高血糖合并舞蹈症 危险因素 病例对照研究 

分 类 号：R742.2[医药卫生—神经病学与精神病学]