尿毒症患者透析后舞蹈样并发症二例分析及文献复习

目的探讨尿毒症患者透析后舞蹈样并发症的临床表现和治疗方法。方法选择2例典型患者进行临床表现及影像学结果回顾性分析。结果尿毒症血透患者维生素B_1缺乏可由多种原因引起,常见于摄入过低和透析中丢失过多。维生素B_1不足,三羧酸循环紊乱,血乳酸增加,从而导致机体出现一系列相关症状。其临床表现多为威尼克氏脑病。结论对尿毒症血透发生基底神经节功能紊乱所引发的舞蹈样症的患者,诊断时应加强对本病的认识。血乳酸和脑基底节影像学检查可为本病提供诊断依据。维生素B_1静脉疗法对本病有明显的缓解作用。

Chorea after chronic hemodialysis in uremic patients:report of two cases and literature review

Objective To study the clinical symptoms and therapeutic strategies of chorea resulted from thiamine deficiency by chronic dialysis during uremia.Methods Retrospective analysis was performed in 2 typical cases about their clinical manifestations and radiological examination results. Results Thiamine deficiency might complicate chronic hemodialysis because of low intake and accelerated loss of thiamine in uremic patients.If the availability of thiamine was reduced,the citric acid cycle was blocked and excess of pyruvate was converted to lactate,which led to the dysfunction in brain and Wernicke's encephalopathy in those of patients.Conclusion Attention should be focused on those patients who just develop chorea induced by thiamine deficiency resulted from hemodialysis.CTs or MRIs screening and examination on serum Vitamin B_1 present the new findings for diagnosis and provide the mechanistic explanation for chorea.Intravenous thiamine leads to a dramatic remission in the 2 cases with chorea.