记忆门诊额颞叶变性登记患者前期诊治情况调查  

A survey of pre-diagnosis and treatment of patients registered with frontotemporal lobar degeneration in a memory clinic

作　　者：王祉涵 王丽棽 佡剑非[1] 郑东明[1] Zhihan WANG;Lishen WANG;Jianfei NAO;Dongming ZHENG(Department of Neurology,Shengjing Hospital Of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院神经内科,沈阳110000

出　　处：《阿尔茨海默病及相关病杂志》2024年第3期200-203,共4页Chinese Journal of Alzheimer's Disease and Related Disorders

摘　　要：目的:调查分析额颞叶变性(frontotemporal lobar degeneration,FTLD)患者记忆门诊就诊前的诊治情况,提高非认知亚专科临床医生对这一疾病的认识。方法:回顾性收集2017年1月至2022年12月期间在中国医科大学附属盛京医院记忆门诊登记的FTLD患者的临床数据,主要包括人口学数据、临床和影像资料、既往就诊经历、既往诊断,并按照行为变异型和失语型进行分组和数据分析。其中行为变异型指行为变异型额颞叶痴呆(behavioral variant of frontotemporal dementia,bvFTD),失语型包括进行性非流利性失语(progressive non-influent aphasia,PNFA)和语义性痴呆(semantic dementia,SD)。同时与本痴呆门诊连续登记的100例阿尔茨海默病(Alzheimer's disease,AD)患者的数据进行比较。结果:研究期限内共有75例FTLD登记患者,包括行为变异型bvFTD患者39例(52.0%),失语型患者36例(48.0%)。失语型包含PNFA患者14例(18.7%)和SD患者22例(29.3%)。FTLD患者年龄为(62.7±7.5)岁,比AD组[(67.8±6.6)岁]显著年轻(P<0.05)。75例FTLD患者中有70例曾在各级医院的非记忆门诊就诊,但仅有3例bvFTD患者得到了正确诊断,诊断正确率为4.3%。100名AD患者中,有63人曾经在非记忆门诊就诊,诊断正确率为44.4%,两者间差异显著(P<0.05)。在之前的就诊过程中,各型FTLD患者进行了认知量表检查的比例均显著低于AD患者,bvFTD患者对疾病的自知力、结构影像检查率均显著低于失语型FTLD和AD组(P<0.05)。bvFTD患者最易被诊断为精神类疾病(48.7%)和AD(26.5%),失语型FTLD容易诊断不清(38.2%)或者诊断为AD(26.5%)、脑血管病(23.5%)。结论:FTLD患者发病年龄比AD早,在非记忆门诊误诊率更高,与临床医生对该病缺乏认识以及检查进行不足有关。Objective:To investigate and analyse the diagnosis and treatment of patients with frontotemporal lobar degeneration(FTLD)before their visits to the memory clinic,and to improve the awareness of non-cognitive subspecialty clinicians about this disorder.Methods:Clinical data of FTLD patients registered at the memory clinic of Shengjing Hospital of China Medical University between January 2017 and December 2022 were retrospectively collected,mainly including demographic data,clinical and imaging data,previous consultation experience,previous diagnosis,and the data were grouped and analysed according to behavioural variant and aphasia type.Behavioural variant refers to behavioural variant of frontotemporal dementia(bvFTD),and aphasia type includes progressive non-influent aphasia(PNFA)and semantic dementia(SD).The data were also compared with those of 100 consecutive patients with Alzheimer's disease(AD)registered in our dementia clinic.Results:A total of 75 patients with FTLD were registered during the study period,including 39(52.0%)patients with behavioural variant bvFTD and 36(48.0%)patients with aphasic type.The aphasic type included 14(18.7%)patients with PNFA and 22(29.3%)patients with SD.The age of the FTLD patients was 62.7±7.5 years,which was significantly younger than that of the AD group(67.8±6.6 years)(P<0.05).Seventy of the 75 patients with FTLD had been seen in non-memory clinics at all hospital levels,but only three patients with bvFTD were correctly diagnosed,a correct diagnosis rate of 4.3%.63 of the 100 AD patients had previously attended a non-memory clinic,with a correct diagnosis rate of 44.4%,a significant difference between the two(P<0.05).The proportion of patients with all types of FTLD who had undergone cognitive scales at previous visits was significantly lower than that of AD patients.bvFTD patients had significantly lower rates of self-perception of illness and structural imaging than the aphasic FTLD and AD groups(P<0.05).bvFTD patients were most likely to be diagnosed with psychiatri

关 键 词：额颞叶变性 误诊 精神障碍 痴呆 神经影像 

分 类 号：R74[医药卫生—神经病学与精神病学]