【摘要】 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-photonemissioncomput-edtomography,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?更多还原

【Abstract】 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.更多还原