糖尿病性非酮症偏侧舞蹈症16例临床分析

Clinical analysis of 16 cases with non-ketotic diabetic and hemichorea

目的分析糖尿病性非酮症偏侧舞蹈症患者临床表现与预后。方法收集在本院收治的16例非酮症糖尿病并伴有偏侧舞蹈症的一般资料、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例患者急性起病12例,占75.0%;临床症状主要为肢体一侧不自主、无规律的类似舞蹈样的动作12例,占75.0%;发病时血糖13.8~26.3mmol·L^(-1),平均发病时血糖(21.3±4.6)mmol·L^(-1)。16例患者CT显示:壳核高密度6例(37.50%),尾状核高密度4例(25.0%),双侧纹状体高密度3例(17.58%),CT未见异常者3例(18.75%);MRI显示:壳核不均匀高信号7例(43.75%),尾状核不均匀高信号6例(37.50%),右颞叶不均匀高信号3例(18.75%);所有患者给予常规胰岛素进行血糖控制在7.7~11.0mmol·L^(-1),给予氟哌啶醇、奋乃静等药物对症治疗,治疗时间22~41d,平均治疗时间28.61±5.14d;出院时患者症状消失14例(87.50%),在出院时仍然有不同程度的偏侧舞蹈症状2例(13.50%)。结论糖尿病性非酮症偏侧舞蹈症患者主要表现为一侧不自主、无规律的类似舞蹈样的动作,控制血糖后给予氟哌啶醇、奋乃静等药物对症治疗预后良好。

Objective To analyse the clinical manifestation and prognosis of hemichorea with nonketotic.Method we collected the clinical data of16hemichorea patients with non-ketotic diabetes,including general information,admission,clinical symptoms and signs,laboratory tests,imaging results,treatment and prognosis.Results All the16patients,12cases had an acute onset(75%)and12cases with the side of the body disorder,non-autonomous action like the dance(75%);blood glucose level at the onset of disease was13.8-26.3mmol·L-1,and the average was21.3±4.6mmol·L-1.Results of CT examination in the16patients were:6cases of putamen high densit(y37.5%),4cases of caudate nucleus high densit(y25.0%),3cases of bilateral striatum high density(17.58%);MRI tests results:7cases of putamen uneven high signal(43.5%),6cases of putamen uneven high signal(37.5%),3cases of putamen uneven high signal(18.75%).All patients were given conventional insulin to control bloodglucose7.7-11.0mmol·L-1,haloperidol and fluphenazine for symptomatic treatment.The treatment time is22-41days,and the average is(28.61±5.14)days.14patients improved and symptoms disappeared(87.50%),and2cases were with different degrees of hemichorea(13.50%).Conclusion The patients with non-ketotic diabetic and hemichorea featured disorder,non-autonomous action like the dance unilaterally,and got good prognosis when treated with haloperidol and fluphenazine after controling the blood glucose.