糖尿病性偏侧投掷症-偏侧舞蹈症临床特点系统综述

Systematic review of diabetic hemiballism-hemichorea

目的探讨糖尿病性偏侧投掷症-偏侧舞蹈症(diabetic hemiballism-hemichorea,DHB-HC)患者典型临床表现、影像学表现及药物治疗效果。方法检索2008-01-01 2018-06-30Medline数据库收录的有关DHB-HC病例报道,严格筛选文献,系统综述DHB-HC患者的临床表现、影像学特征及预后。结果共纳入23篇文献,53例患者,其中35例(66.0%)为亚裔;男13例(24.5%)、女40例(75.5%),年龄14~91岁,中位数74岁,四分位数间距16岁;5例(9.4%)表现双侧舞蹈症状,48例(90.6%)偏身舞蹈症状;42例患者行头颅 MR检查,33例(78.6%)发现基底节区T1加权像高信号;单纯降糖治疗者24例(45.3%),降糖同时加用对症药物治疗者29例(54.7%),53例患者舞蹈症状均缓解或消失,3例(5.7%)患者1年内复发。结论 DHB-HC好发于亚裔老年女性,其临床特征多为偏侧症状,发病时呈高血糖、高糖化血红蛋白、酮体阴性、头颅 MR基底节T1加权像高信号,积极控制血糖及对症治疗有助于缩短病程,提高预后。

Objective To investigate the typical clinical characteristics,imaging findings and drug therapy of diabetic hemiballism-hemichorca(DHB-HC).Methods Literature related to DHB-HC case reports included in Medline database from January 1,2008 to June 30,2018 were searched according to strict standards,and the clinical manifestations,imaging characteristics and prognosis of the DHB-HC patients were reviewed.Results 23 papers involving 53 patients were finally included.35 cases(66.0%) were Asian patients.There were 13 males(24.5%) and 40 females(75.5%),aged from 14 to 91 years old,with a median age of 74(interquartile range:16 years old).5 patients(9.4%) showed bilateral dancing symptoms,and 48 patients(90.6%) showed hemidancing symptoms.MR examination was performed in 42 patients and hyperintensity in T1-weighted imaging was found in 33 patients(78.6%).24 of the 53 patients(45.3%) had spontaneous remission by hypoglycemic therapy only,29 patients(54.7%) had remission by additional allopathic drug,3 patients(5.7%) relapsed within 1 year.Conclusions DHB-HC is commonly seen in elderly Asian women.Its characteristics arc mostly one-sided symptoms;hyperglycemia,hyperglycosylated hemoglobin,negative ketone body,and hyperintensity in T1 image at basal ganglia present at the onset.Active control of blood glucose and symptomatic treatment arc helpful to shorten the course of disease and improve the prognosis.