非酒精性Wernicke脑病临床特征分析

Investigation on diagnosis and treatment of non-alcoholic Wernicke encephalopathy

关键词:  Wernicke脑病  硫胺素  诊断

Key words:  Wernicke encephalopathy  thiamine  diagnosis

摘要:

目的 总结非酒精性Wernicke脑病的临床特点及诊断和治疗策略。方法 收集16例非酒精性Wernicke脑病患者，其中男7例，女9例，年龄28~77（56.3±15.2）岁。16例患者均无长期饮酒史、均存在硫胺素缺乏的病因，10例为胃肠道手术后，3例为恶性肿瘤化疗，1例为慢性结肠炎呕吐，1例为神经性厌食，1例为妊娠呕吐。总结16例患者临床表现、辅助检查资料、治疗及转归情况。结果 16例患者临床表现为有明确营养不良史14例，眼征12例，共济失调9例，精神障碍10例。有典型"三主征"的患者3例（18.8%）。8例出现颅MRI特征性表现。给予大剂量维生素B1治疗后症状完全缓解12例，部分缓解4例。结论 对可能存在硫胺素缺乏的患者需要高度警惕并发非酒精性Wernicke脑病，临床诊断不应局限于经典的"三主征"，尽早识别及足量应用维生素B1是治疗非酒精性Wernicke脑病的关键。

Abstract:

Objective To investigate the clinical diagnosis and treatment strategy of non-alcoholic Wernicke encephalopathy. Methods The study was a retrospective analysis of 16 non-alcoholic patients admitted with a diagnosis of Wernicke encephalopathy. There were 7 males and 9 females, aged from 28-77 (56.3±15.2) years. All 16 patients in this group had no long-term history of consumption and all had the etiology of thiamine deficiency, among these, 10 patients were treated with gastrointestinal surgery, 3 patients with malignant tumor chemotherapy, 1 patient with chronic colitis vomiting, 1 patient with anorexia nervosa, and 1 with pregnancy vomiting. Results 14 patients had the history of malnutrition, 12 patients had ocular signs, 9 patients had ataxia, and 10 were in mental disorders. The triad of Wernicke encephalopathy was seen in only 3 patients (18.8%). 8 patients had characteristic manifestations on MRI examination.After treatment with large dose of Vitamin B1, 12 patients were completely recovered and 4 were relieved. Conclusion Wernicke encephalopathy should be highly vigilant in patients with thiamine deficiency,and should not be limited to the classic three main signs; Early indentification and adequate application of Vitamin B1 are the keys to the treatment of non-alcoholic Wernicke encephalopathy.