低血糖脑病的临床及脑部磁共振特征

Clinical and brain magnetic resonance imaging features of hypoglycemic encephalopathy

目的探讨低血糖脑病的临床及脑部磁共振特征。方法回顾分析69例低血糖昏迷患者的临床、脑磁共振(MRI)成像资料。结果低血糖昏迷诱因较为复杂,常见的为进食减少、腹泻、上呼吸道感染、降糖药物应用不当等。临床表现复杂多样,除意识障碍外,还可表现为偏瘫、四肢瘫、凝视麻痹等,多数伴有Babinski征。69例患者中有18例出现脑MRI DWI异常高信号病灶,病灶主要累及海马、基底节、大脑皮质以及皮质下白质,多为对称性损害。3个月后随访,不伴有脑部MRI损害的患者预后良好率明显高于伴有脑部MRI损害的患者(94.12%对22.22%;P=0.0011)。伴有脑部MRI损害者有10例患者预后不良,其中9例(90%)发生于皮质受累患者。结论低血糖脑病临床表现不具有特异性,对于昏迷患者,应当考虑到低血糖的可能。降糖药物应用不当为低血糖脑病的主要诱发因素。脑部MRI要优于脑部CT检查,其中DWI序列对于检测低血糖所致的脑部损害有着非常重要的意义。皮质受累者预后不良。

Objective To investigate the clinical and brain magnetic resonance imaging （MRI） features of hypoglycemic encephalopa- thy （HE）. Methods The clinical features and brain MRI data of 69 patients with hypoglycemic coma （HC） were analyzed retrospec- tively. Results The causative factors of HC were complex and usually included poor appetite, diarrhea, upper respiratory tract infec- tion, and improper use of hypoglycemic drugs. These patients had various clinical manifestations, including disturbance of conscious- ness, hemiplegia, tetraplegia, gaze palsy, and Babinski sign （seen in most cases）. Eighteen cases were found to have abnormal hy- perintensity on DWI of the brain, mainly involving the hippocampus, basal ganglia, cerebral cortex, and subcortical white matter, and most of them had bilateral, symmetrical lesions. The patients without brain damage on MRI had a significantly higher percentage of in- dividuals with a good outcome than those with brain damage on MRI, （94.12% vs 22.22% , P =0. 0011 ）, according to the follow-up conducted at 3 months after treatment. Ten of the patients with brain damage on MRI had a poor outcome, and 9（90% ） of them had cortical damage. Conclusions HE has no specific clinical manifestations, and hypoglycemia should be considered for patients with co- ma, especially the elderly. Improper use of hypoglycemic drugs is the main trigger for HE. Brain MRI is superior to brain CT, and the DWI sequence is of great significance for testing the brain damage caused by hypoglycemia. The patients with cortical damage have a poor prognosis.