糖尿病非酮症偏侧舞蹈症1例及文献复习

Hemichorea Associated with Non-Ketotic Hyperglycemia: 1 Case Report and a Review of the Literature

摘要: 目的：通过探讨非酮症高血糖性偏侧舞蹈症患者的临床表现、诊断和治疗、发病机制，提高对本病的认识，做到早期识别、早期治疗，避免误诊、漏诊。方法：分析1例济宁医学院附属医院的糖尿病非酮症偏侧舞蹈症患者的临床症状、体征、影像学资料、治疗方法，并复习相关文献。结果：本例糖尿病非酮症偏侧舞蹈症患者，舞蹈样动作较明显，既往患者血糖控制不规律。患者入院随机血糖：14 mmol/L，糖化血红蛋白：11%，血酮体：3.6 mg/dl；颅脑CT示左侧基底节区高密度影；颅脑MRI T1WI可见左侧基底节区高信号。入院后经积极控制血糖水平，1周后舞蹈样症状完全消失。结论：对于糖尿病非酮症偏身舞蹈症的患者做到早期识别、早期干预，积极控制血糖水平，科学合理地加用抗精神病药物，控制患者舞蹈样动作，其预后良好，并提高了患者的生活质量。

Abstract: Objective: To improve the understanding of this disease by discussing the clinical manifestations, diagnosis, treatment and pathogenesis of patients with non-ketotic hyperglycemic hemichorea, to achieve early recognition and early treatment, and to avoid misdiagnosis and missed diagnosis. Methods: The clinical symptoms, signs, imaging data and treatment of a patient with non-ketotic hyperglycemic hemichorea from the Affiliated Hospital of Jining Medical College were analyzed, and the relevant literature was reviewed. Results: This case of hemichorea associated with non-ketotic hyperglycemia had more pronounced dance-like movements and irregular glycemic control in previous patients. The patient was admitted with random blood glucose: 14 mmol/L, glycosylated hemoglobin: 11%, blood ketone bodies: 3.6 mg/dl; cranial CT showed high-density shadow in the left basal ganglia region; cranial MRI T1WI showed high signal in the left basal ganglia region. After admission, the chorea-like symptoms completely disappeared after 1 week after active control of blood glucose level. Conclusion: For patients with non-ketotic hyperglycemic hemichorea to achieve early identification, early intervention, active control of blood glucose level, scientific and reasonable addition of antipsychotic drugs to control the patient’s chorea-like movements, their prognosis is good and the quality of life of patients is improved.