老年患者丙戊酸脑病4例分析

Analysis of 4 Cases of Elderly Valproate Encephalopathy

目的：回顾分析老年患者丙戊酸脑病的临床及实验室检查特点,提高对丙戊酸脑病的认识及诊断水平。方法：收集我院神经内科2010年1月-2014年12月应用丙戊酸钠（VPA）后确诊为丙戊酸脑病患者4例,比较其临床表现及实验室检查的特点。结果：4例患者中男3例,女1例,平均年龄（70.3±9.8）岁;均为单用VPA;表现为意识障碍、认知功能下降;肝功能及丙戊酸钠血药浓度均在正常范围,血氨浓度升高;脑电图提示广泛漫波增多,以θ和δ波占优;4例患者停用VPA 2周后症状改善,血氨浓度下降。结论：丙戊酸脑病突出临床表现为意识障碍、认知功能下降,临床使用VPA时应予以高度重视。及时停药后症状可逐缓解,其愈后良好。

Objective： Retrospective analyzed the clinical and laboratory examination features of valproate encephalopathy in senile patients,to improve the comprehending and diagnostic level on valproate encephalopathy. Methods： Compared the clinical and laboratory characteristics of 4 patients of valproate encephalopathy after treating with valproic acid from neurology department of our hospital from January 2010 to December 2014. Results： The average age of 4 patients（ 3 men and 1 woman） was（ 70. 3 ± 9. 8） years,who were treated by valproic acid alone. The all cases showed consciousness disorder and cognitive impairment. Both liver function and valproate plasma concentration were within the normal range,but the plasma ammonia concentration was increasing. Furthermore,EEG indicated slow- waves increased widely,especially θ and δ waves. The 4 cases experienced a clinically significant improvement in symptoms in 2 weeks after stopping use of valproic acid,whose plasma ammonia concentration came down. Conclusion： The prominent clinical manifestations of valproate encephalopathy were consciousness disorder and cognitive decline. So we should pay high attention to the clinical application of valproic acid. Fortunately,those related symptoms would get alleviated gradually after cessation of valproate timely,and the prognosis of it was favorable.