尿毒症患者透析后舞蹈样并发症2例分析及文献复习

Chorea in Chronic Hemodialysis:Report of Two Cases and Review of the Literature

尿毒症血透患者维生素B1缺乏由多种原因引起,常见于摄入过低和透析中丢失过多。维生素B1不足,三羧酸循环紊乱,血乳酸增加,从而导致机体出现一系列相关症状。其临床表现多为威尼克氏脑病。单独出现基底神经节功能紊乱所引发的舞蹈样症则不多见,本文选择2例作典型报道。血乳酸和脑基底节影像学检查可为本症提供诊断依据。维生素B1静脉疗法对本病有明显的缓解作用。

Thiamine deficiency may complicate chronic dialysis because of low intake and accelerated loss of thiamine in uremia patients.If the availability of thiamine is rsduced,the citric acid cyele is blocked and excess of pyruvate is converted to lactate that leads to the dysfunction in brain and results in Wernick's encephalopathy in those of patients.However,it is unusual in those patients who just develop chorea induced by thiamine deficiency resulted from hemodialysis.Here two cases were described and we propose CTs or MRIs screening and examination on serum Vitamin B1 represent the new findings for diagnosis and provide the mechanistic ixplanation for chorea.Intravenousthiamine lid to a dramatic response in two cases with chorea.