糖尿病性纹状体病16例临床特点分析  

Clinical characteristic analysis of 16 patients with diabetic striatopathy

作　　者：詹自雄[1,2] 江秀龙 林守华[1,2] 汪银洲 张旭[1,2] Zhan Zixiong;Jiang Xiulong;Lin Shouhua;Wang Yinzhou;Zhang Xu(Department of Neurology,Fujian Provincial Hospital&Affiliated Provincial Teaching Hospital of Fujian Medical University,Fuzhou,Fujian 350001,China)

机构地区：[1]福建省立医院神经内科,福建福州350001 [2]福建医科大学省立临床医学院

出　　处：《齐齐哈尔医学院学报》2024年第4期324-329,共6页Journal of Qiqihar Medical University

基　　金：福建省卫生计生委青年科研课题基金(2015/1/8)。

摘　　要：目的 分析糖尿病性纹状体病患者临床表现与预后。方法 收集2017年1月—2022年1月本院连续收治并随访的16例糖尿病性纹状体病患者的一般资料、入院情况、临床症状和体征、实验室检查、影像学检查结果、治疗和预后等资料,总结其临床特点和预后。结果 16例患者中女9例,男7例,平均发病年龄(71.5±12.4)岁;3例(18.8%,3/16)为双侧肢体舞蹈表现,其余为单侧症状;就诊时平均血糖为(29.6±16.3)mmol/L;平均糖化血红蛋白占比为(14.6±2.8)%;50%(8/16)的患者尿酮体为阴性,剩余患者尿酮体为微量至轻度阳性。16例患者颅脑磁共振检查则发现10例存在纹状体区域内病灶;其中9例患者进行了CTA或者MRA脑血管评估,发现4例(44%,4/9)存在脑大动脉的重度狭窄。经治疗,11例(69%,11/16)患者症状完全缓解,剩余5例(31%,5/16)症状反复。4例患者并发肺部感染,2例患者继发脑梗死。15例患者使用抗栓治疗,诊治及随访期间未见脑出血。结论 糖尿病性纹状体病患者除了经典的表现外还可出现双侧症状及尿酮弱阳性;胰岛素控制血糖的同时给予氟哌啶醇、氯硝西泮等药物对症治疗预后多良好,部分患者可继发肺部感染及脑梗死,抗栓治疗可能并不显著增加脑出血风险。Objective To analyze the clinical manifestations and prognosis of patients with diabetic striatal disease.Methods Data including general information,admission status,clinical symptoms and signs,laboratory and imaging examination results,treatment methods,and prognosis were collected from 16 patients with diabetic striatal disease who were continuously admitted to our hospital and followed up during January 2017 and January 2022.The clinical characteristics and prognosis of patients were summarized.Results Among the 16 patients,9 were female and 7 were male,with a mean age of onset of(71.5±12.4) years.Three patients(18.8%,3/16) presented with bilateral choreic movements,while the remainder had unilateral symptoms.The mean blood glucose level at admission was 29.6±16.3 mmol/L,and the mean glycated hemoglobin proportion was(14.6±2.8)%.Urine ketone bodies of fifty percent(8/16) of the patients were negative,while the remaining patients were trace to mildly positive urine ketone bodies.Magnetic resonance imaging of the brain in all 16 patients revealed lesions within the striatum region in 10 cases.Nine of these patients underwent CTA or MRA cerebrovascular evaluation,and 4(44%,4/9) were found to have severe large artery stenosis.11 patients(69%,11/16) had complete resolution of symptoms after treatment,while the remaining 5(31%,5/16) had recurrent symptoms.4 patients developed pulmonary infection,and 2 patients developed secondary cerebral infarction.15 patients received antithrombotic therapy,and no cerebral hemorrhage was observed during the treatment and follow-up period.Conclusions In addition to the classic symptoms,patients with diabetes striatum disease may also present with bilateral symptoms and weak positive urine ketone test.The prognosis is generally good among the patients received symptomatic treatment with haloperidol,clonazepam and other drugs in addition to controls blood sugar with insulin.However,some patients may develop secondary pulmonary infections and cerebral infarction.Anti thrombotic the

关 键 词：糖尿病性纹状体病 偏侧舞动症 临床分析 并发症 预后 

分 类 号：R747.9[医药卫生—神经病学与精神病学]