海洛因海绵状白质脑病患者的病变分析及综合康复治疗效果随访

背景有关海洛因海绵状白质脑病国内外文献报道极少,目前在诊断及MRI特征性改变方面国内已有人作概括,有关病理特点也正在探讨 ,如何对其实施康复治疗,国内外鲜有报道.目的探讨海洛因海绵状白质脑病的病理机制及综合康复治疗方案.设计以诊断为依据的回顾性分析研究. 地点和对象 2001-01/2003-06在深圳市人民医院神经内科住院的4例确诊海洛因中毒性脑病的患者为研究对象. 干预对 4例确诊海洛因中毒性脑病患者实施包括药物(地塞米松、脑多肽、胞二磷胆碱、B族维生素等 )、低强度激光血管内照射、高压氧、平衡功能训练、针灸、心理疏导等系统综合康复治疗,评价疗效,探讨综合康复治疗方案.主要结局观察指标治疗后患者的认知、心理、语言等方面的恢复.同时采用单光子发射型计算机断层扫描显像(single-photon emission computed tomography,SPECT)评价血液供应和功能恢复. 结果治疗10周后临床评价,患者在认知、心理、语言、平衡功能、步行、日常生活能力等方面均有显著改善.认知长谷川式量表智力测定,4例患者治疗前评分分别为 9, 8, 28, 26分,治疗后分别为 35, 32, 35, 35;心理病例1、 2对毒品戒断、成瘾症状、心理渴求均消失;语言治疗后病例 1构音清,语言流利,病例 2、病例 3小脑性语言明显减轻;平衡上田敏平衡反应试验治疗前分别为3, 7, 10, 11分,治疗后分别为 18, 20, 16, 17分; ADL生活能力( MBI评分)治疗前为35, 40, 30, 40分,治疗后分别为 95, 100, 90, 95分. SPECT评价上述 4例治疗前脑单光子发射计算机断层扫描(SPECT)显像均示双侧小脑、双基底节区等脑血流灌注障碍,脑细胞功能严重受损,治疗后复查,上述区域血供和功能明显提高.结论对海洛因中毒性脑病采用综合康复治疗方案,有利于患者的康复.其病理机制,除与中枢神经系统脱髓鞘和免疫反应有关外,也与脑缺血缺氧有关.

Pathological changes in heroin-induced spongiform leukoencephalopathy and therapeutic effect of comprehensive rehabilitation:a follow-up study

BACKGROUND:Documentation of heroin-induced spongiform leukoencephalopathy(HSLE) in heroin addicts is scarce in both Mainland China and abroad.Chinese researchers have attempted to define the diagnosis and characteristic changes in magnetic resonance imaging(MRI) of this disease,with ongoing studies of the features in the pathological changes,but the implementation of rehabilitation treatment for HSLE patients has not been addressed. OBJECTIVE:To explore the pathological mechanism and effective comprehensive rehabilitation protocol of HSLE. DESIGN:Diagnosis-based retrospective analysis. SETTING and PARTICIPANTS:Between January 2001 and June 2003,4 heroin addicts were identified to have toxic encephalopathy in the Department of Neurology,the People's Hospital of Shenzhen. INTERVENTIONS:The 4 patients with HSLE received comprehensive rehabilitation treatment including medication with dexametasone,encephalon polytide,cytidine diphosphate choline,and Vitamin B,intravascular irradiation with low-energy laser,hyperbaric treatment,balance training, acupuncture,and psychological consultation,etc.and the therapeutic effects were observed to formulate the optimal comprehensive rehabilitation treatment protocol. MAIN OUTCOME MEASURES:Recoveries in cognition,psychology and linguistic ability were observed,with the blood supply and functional recovery assessed by single-photon emission computed tomography(SPECT). RESULTS:Clinical assessment was performed 10 weeks after treatment,which yielded significant improvement in cognition,psychology,linguistic ability,balance,as well as walking and ability to perform daily activities.Changguchun scale for intelligence assessment was adopted to evaluate the patients' cognition.The scores were 9,8,28 and 26 respectively before treatment for the 4 cases,while 35,32,35 and 35 respectively after treatment.In term of psychological improvement,the symptoms of drug abstinence,addiction and desire disappeared in case 1 and 2.Linguistic abilities were improved in 3 patients,of whom patient 1 was capable of speaking clearly and fluently after treatment,with patients 2 and 3 found to have significantly alleviated cerebellar language involvement.In balance response examination,patient 1 scored 18 after treatment vs 3 before treatment,and the other 3 patients scored 20 vs 7,16 vs 10, and 17 vs 11 respectively. The MBI scores for activity of daily life were 95 after treatment vs 35 before treatment in case 1, 100 vs 40 in case 2, 90 vs 30 in case 3,and 95 vs 40 in case 4.SPECT examination showed insufficient blood supply in the bilateral cerebellum and basal ganglia with severe functional impairment of the brain cells in all 4 cases,which were obviously improved after treatment. CONCLUSION:Comprehensive rehabilitation benefits the recovery of patients with HSLE.The pathological mechanism of HSLE involves not only the central nervous demyelination and immune response,but also cerebral ischemia and hypoxia.