不宁腿综合征的病理生理学和诊断治疗的研究进展

Research progress in the pathophysiology,and diagnosis and treatment of restless legs syndrome

不宁腿综合征(restless legs syndrome,RLS)是一种常见的神经系统疾病,特点是不舒服的腿部冲动,在运动或起身行走时缓解,并在夜间症状加重。RLS的发病机制仍不清楚,但随着病理生理学研究的进展,发现可能涉及中枢神经系统的多巴胺功能障碍,以及其他未确定的促进机制,特别是缺铁和慢性肾功能障碍。有家族史的遗传易感性很常见。RLS增强的特点是症状的严重性更强,症状发生的时间更早,而且常常是症状从腿部扩散至手臂或身体其他区域。一些RLS患者通过非药物措施,如按摩和温水浴,可以充分控制症状。一线治疗方案包括对体内铁储存减少的人进行铁补充治疗,或使用加巴喷丁、普瑞巴林,以及多巴胺激动剂,如普拉克索、罗匹尼罗和罗替戈汀。二线疗法包括曲马多、羟考酮和美沙酮等阿片类药物。RLS严重影响患者的生活质量,且仍是一个非常需要创新的治疗领域,需要有更多新的、有生物依据的治疗方法。

Restless legs syndrome(RLS)is a common neurological disorder characterized by uncomfortable leg impulses that resolve with exercise or getting up to walk and worsen at night.The pathogenesis of RLS is thrown unclear,but with advances in pathophysiological studies,it has been found that dopamine dysfunction in the central nervous system may be involved,as well as other unidentified contributing mechanisms,particularly iron deficiency and chronic renal dysfunction.Genetic susceptibility with a family history is common.enhanced RLS is characterized by greater severity of symptoms,earlier onset of symptoms,and often spread of symptoms from the legs to the arms or other areas of the body.Some people with RLS can adequately control their symptoms with non-pharmacological measures such as massage and warm baths.First-line treatment options include iron sup⁃plementation for those with evidence of reduced iron stores in the body,or the use of gabapentin or pregabalin,and dopamine agonists such as pramipexole,ropinirole,and rotigotine.Second-line therapies include opioids such as tramadol,oxycodone,and methadone.RLS severely affects the quality of life of patients and remains an area of treatment in great need of innovation and more new,biologically based and therapeutic approaches.