多系统萎缩临床辨析及康复治疗思路
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摘要
<正>多系统萎缩(multiple system atrophy,MSA)病理学机制为神经胶质细胞中α-突触核蛋白广泛、异常聚集形成嗜酸性包涵体,阻碍突触末梢神经递质释放,影响神经信号传导导致神经细胞变性。神经病变主要为纹状体及黑质体变性,下橄榄体、脑桥、小脑、壳核萎缩等。临床表现以自主神经功能失常、帕金森样表现、共济失调等症状为主,其中自主神经症状如体位性低血压、泌尿生殖障碍、呼吸障碍等是MSA诊断的必要条件[1]。MSA起病隐匿,呈进展性
引文
[1] Gilman S,Wenning GK,Low PA,et al. Second consensus statement on the diagnosis of multiple system atrophy[J]. Neurology,2008,71(9):670-676
[2] Ozawa T,Onodera O. Multiple system atrophy: clinicopathological characteristicsin Japanese patients[J]. Proc Jpn Acad Ser B Phys Biol Sci,2017,93(5):251-258
[3] 张海玲,宋东东,邱峰,等. 多系统萎缩非运动症候的临床研究[J]. 中华老年心脑血管病杂志,2014,16(9):946-950
[4] 张海玲,戚晓昆. 多系统萎缩的自主神经功能障碍及其他非运动症候[J]. 中国神经免疫学和神经病学杂志,2014,21(2):138-140
[5] K?llensperger M,Geser F,Ndayisaba JP,et al. Presentation, diagnosis, and management of multiple system atrophy in Europe:nal analysis of the European Multiple System Atrophy registry[J]. Mov Disord,2010,25(15):2604-2612
[6] Shindo K,Tsuchiya M,Ichinose Y,et al. Vasomotor regulation in patients with multiple system atrophy[J]. J Neural Transm (Vienna),2017,124(4):477-481
[7] 吕亚峰,王焕霞,秦巧云. 多系统萎缩患者早餐后血压及心功能变化[J]. 郑州大学学报:医学版,2017,52(4):510-512
[8] Yamamoto T1,Sakakibara R,Uchiyama T,et,al. When is Onuf's nucleus involved in multiple system atrophy A sphincter electromyography study[J]. J Neurol Neurosurg Psychiatry, 2005,76(12):1645-1648
[9] Augustis S,Saferis V,Jost WH. Autonomic disturbances including impaired hand thermoregulation in multiplesystem atrophy and Parkinson's disease[J]. J Neural Transm (Vienna),2017,124(8):965-972
[10] Abbott SM,Videnovic A. Sleep disorders in atypical Parkinsonism[J]. Mov Disord Clin Pract,2014,1(2):89-96
[11] 吴兴华,王志伟,戚晓昆. 电生理检测在多系统萎缩与帕金森病诊断及鉴别诊断中的研究进展[J]. 中华老年心脑血管病杂志,2016,18(12):1337-1339
[12] Iranzo A,Santamaria J,Tolosa E. The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases[J]. Sleep Med Rev,2009,13(6):385-401
[13] Nomura T1,Inoue Y,H?gl B,et al. Comparison of the clinical features of rapid eye movement sleep behavior disorder in patients with Parkinson's disease and multiple system atrophy[J]. Psychiatry Clin Neurosci,2011,65(3):264-271
[14] Iranzo A. Sleep and breathing in multiple system atmphy[J]. Curr Treat Options Neural,2007,9(5):347-353
[15] Ramaligam V,Chen MC,Saper CB,et al. Perspectives on the rapid eye movement sleep switch in rapid eye movement sleep behavior disorder[J]. Sleep Med,2013,14(8):707-713
[16] 侯春蕾,荣培,郑文静,等. 多系统萎缩的睡眠结构研究[J]. 中日友好医院学报,2016,30(2):77-79;83
[17] Flabeau O,Ghorayeb I,Perez P,et al. Impact of sleep apnea syndrome on survival in patients with multiple system atrophy[J]. Parkinsonism Relat Disord,2017,35:92-95
[18] 张尊胜,胡珍珠,李可,等. 多系统萎缩合并继发性Ondine's curse综合征的临床及影像学特点(附5例报告)[J]. 临床神经病学杂志,2015,28(06):460-462
[19] 张国华. 磁共振测量小脑中脚宽度在多系统萎缩与帕金森病鉴别诊断中的价值[J]. 中国实用神经疾病杂志,2015,18(9):81-82
[20] 柏琦,陶霖,佡剑非,等. 多系统萎缩表现典型“十字征”1例[J]. 医学影像学杂志,2015,25(7):1316-1317
[21] 姚群,祝东林,肖朝勇,石静萍. 多系统萎缩患者静息态下脑活动的局部一致性[J]. 南京医科大学学报:自然科学版,2017,37(4):499-503
[22] Benarroch EE,Schmeichel AM,Sandroni P,et al. Parisi JE.Differential involvement of hypothalamic vasopressin neurons inmultiple system atrophy[J]. Brain,2006,129(Pt 10):2688-2696
[23] Deguchi K1,Sasaki I,Touge T,et al. Abnormal baroreceptor-mediated vasopressin release as possible marker in early diagnosis of multiple system atrophy[J]. J Neurol Neurosurg Psychiatry,2004,75(1):110-115
[24] Mocan M,Terhes LM,Blaga SN. Difficulties in the diagnosis and management of hyponatremia[J]. Clujul Med,2016,89(4):464-469
[25] 谢曼青,张燕,王含,崔丽英. 多系统萎缩伴抗利尿激素分泌不当综合征三例临床分析[J]. 中国现代神经疾病杂志,2017,17(2):133-137
[26] Zhao Q,Yang X,Tian S,et al. Association of the COQ2V393A variant with risk of multiple system atrophy in East Asians:a case-control study and meta-analysis of the literature[J]. Neurol Sci,2016,37(3):423-430
[27] 杨百元,沈浩,钟伟,汪洋. 多系统萎缩患者的血尿酸与肌酐水平分析[J]. 中国实用神经疾病杂志,2016,19(23):67-69
[28] Chen D,Wei X,Zou J,et al. Contra-Directional Expression of Serum Homocysteine and Uric Acid as Important biomarkers of Multiple System Atrophy Severity:A Cross-Sectional Study[J]. Front Cell Neurosci,2015,6(9):247
[29] 张志叶,王莉. 治疗神经源性体位性低血压新药屈昔多巴[J]. 中国新药杂志,2015,24(19):2164-2166;2226
[30] Wenning GK,Geser F,Krismer F,et al. The natural history of multiple system atrophy:a prospective European cohort study[J]. Lancet Neurol,2013,12(3):264-274
[31] Constantinescu R,Richard I,Kurlan R. Levodopa responsiveness in disorders with parkinsonism:a review of the literature[J]. Mov Disord,2007,22(15):2141-2148
[32] Friess E,Kuempfel T,Modell S,et al. Paroxetine treatment improves motor symptoms in patients with multiple system atrophy[J]. Parkinsonism Relat Disord,2006,12(7):432-437
[33] 许玉珉,马云枝,沈晓明. 补肾归元法论治多系统萎缩临证探微[J]. 中医临床研究,2015,7(1):70-71
[34] 司维. 周绍华益气温阳法治疗多系统萎缩经验总结[J]. 中西医结合心脑血管病杂志,2016,14(6):669-671
[35] 于春霞. 补中益气汤加减治疗多系统萎缩19例疗效观察[J]. 新中医,2010,42(12):57-58
[36] 宁侠,毛丽军. 周绍华以益气温阳法治疗神经系统疾病经验[J]. 北京中医药,2012,31(2):96-99
[37] 徐昭,贾玉洁. 枕三经排刺法治疗多系统萎缩小脑型患者15例临床观察[J]. 中医杂志,2016,57(20):1764-1767
[38] 马涛,韩景献. 枕三经排刺法治疗恢复期小脑梗塞性眩晕32例[J]. 时珍国医国药,2008,19(3):731
[39] 虞定海. 中国传统保健体育与养生[M]. 上海:上海科学技术出版社,2001:234-267
[40] 韩平,梁杰,王晓玲,等. 八段锦改善老年人运动控制能力的作用机制分析[J]. 福建中医药,2015,46(1):1-2
[41] 刘晓云,尹兵祥. 八段锦运动疗法预防社区老年人跌倒的应用及效果[J]. 护理研究,2016,30(2):423-425
[42] 殷萱,姚斐,孙萍萍,等. 易筋经与核心稳定性训练的比较分析[J]. 上海中医药大学学报,2015,29(4):12-15
[43] 鄢晓枫. 六字诀和八段锦训练对慢性心力衰竭患者运动耐量的影响[J]. 中国中医药现代远程教育,2016,14(16):126-128
[44] 周国庆,姚新苗,李华,等. 六字诀与腰椎核心稳定性训练的内在联系[J]. 康复学报,2016,26(4):47-51
[45] 张瑞锋,殷竞争,周玉帅,等. 多系统萎缩患者皮肤组织中泛素和α-突触核蛋白的表达[J]. 郑州大学学报:医学版,2015,50(3):358-361
[46] 宫殿荣,于海燕,赵敏,等. 寰枕间隙侧方穿刺移植脐血单个核细胞治疗多系统萎缩的临床观察[J/CD]. 中华细胞与干细胞杂志:电子版,2016,6(2):115-120
[2] Ozawa T,Onodera O. Multiple system atrophy: clinicopathological characteristicsin Japanese patients[J]. Proc Jpn Acad Ser B Phys Biol Sci,2017,93(5):251-258
[3] 张海玲,宋东东,邱峰,等. 多系统萎缩非运动症候的临床研究[J]. 中华老年心脑血管病杂志,2014,16(9):946-950
[4] 张海玲,戚晓昆. 多系统萎缩的自主神经功能障碍及其他非运动症候[J]. 中国神经免疫学和神经病学杂志,2014,21(2):138-140
[5] K?llensperger M,Geser F,Ndayisaba JP,et al. Presentation, diagnosis, and management of multiple system atrophy in Europe:nal analysis of the European Multiple System Atrophy registry[J]. Mov Disord,2010,25(15):2604-2612
[6] Shindo K,Tsuchiya M,Ichinose Y,et al. Vasomotor regulation in patients with multiple system atrophy[J]. J Neural Transm (Vienna),2017,124(4):477-481
[7] 吕亚峰,王焕霞,秦巧云. 多系统萎缩患者早餐后血压及心功能变化[J]. 郑州大学学报:医学版,2017,52(4):510-512
[8] Yamamoto T1,Sakakibara R,Uchiyama T,et,al. When is Onuf's nucleus involved in multiple system atrophy A sphincter electromyography study[J]. J Neurol Neurosurg Psychiatry, 2005,76(12):1645-1648
[9] Augustis S,Saferis V,Jost WH. Autonomic disturbances including impaired hand thermoregulation in multiplesystem atrophy and Parkinson's disease[J]. J Neural Transm (Vienna),2017,124(8):965-972
[10] Abbott SM,Videnovic A. Sleep disorders in atypical Parkinsonism[J]. Mov Disord Clin Pract,2014,1(2):89-96
[11] 吴兴华,王志伟,戚晓昆. 电生理检测在多系统萎缩与帕金森病诊断及鉴别诊断中的研究进展[J]. 中华老年心脑血管病杂志,2016,18(12):1337-1339
[12] Iranzo A,Santamaria J,Tolosa E. The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases[J]. Sleep Med Rev,2009,13(6):385-401
[13] Nomura T1,Inoue Y,H?gl B,et al. Comparison of the clinical features of rapid eye movement sleep behavior disorder in patients with Parkinson's disease and multiple system atrophy[J]. Psychiatry Clin Neurosci,2011,65(3):264-271
[14] Iranzo A. Sleep and breathing in multiple system atmphy[J]. Curr Treat Options Neural,2007,9(5):347-353
[15] Ramaligam V,Chen MC,Saper CB,et al. Perspectives on the rapid eye movement sleep switch in rapid eye movement sleep behavior disorder[J]. Sleep Med,2013,14(8):707-713
[16] 侯春蕾,荣培,郑文静,等. 多系统萎缩的睡眠结构研究[J]. 中日友好医院学报,2016,30(2):77-79;83
[17] Flabeau O,Ghorayeb I,Perez P,et al. Impact of sleep apnea syndrome on survival in patients with multiple system atrophy[J]. Parkinsonism Relat Disord,2017,35:92-95
[18] 张尊胜,胡珍珠,李可,等. 多系统萎缩合并继发性Ondine's curse综合征的临床及影像学特点(附5例报告)[J]. 临床神经病学杂志,2015,28(06):460-462
[19] 张国华. 磁共振测量小脑中脚宽度在多系统萎缩与帕金森病鉴别诊断中的价值[J]. 中国实用神经疾病杂志,2015,18(9):81-82
[20] 柏琦,陶霖,佡剑非,等. 多系统萎缩表现典型“十字征”1例[J]. 医学影像学杂志,2015,25(7):1316-1317
[21] 姚群,祝东林,肖朝勇,石静萍. 多系统萎缩患者静息态下脑活动的局部一致性[J]. 南京医科大学学报:自然科学版,2017,37(4):499-503
[22] Benarroch EE,Schmeichel AM,Sandroni P,et al. Parisi JE.Differential involvement of hypothalamic vasopressin neurons inmultiple system atrophy[J]. Brain,2006,129(Pt 10):2688-2696
[23] Deguchi K1,Sasaki I,Touge T,et al. Abnormal baroreceptor-mediated vasopressin release as possible marker in early diagnosis of multiple system atrophy[J]. J Neurol Neurosurg Psychiatry,2004,75(1):110-115
[24] Mocan M,Terhes LM,Blaga SN. Difficulties in the diagnosis and management of hyponatremia[J]. Clujul Med,2016,89(4):464-469
[25] 谢曼青,张燕,王含,崔丽英. 多系统萎缩伴抗利尿激素分泌不当综合征三例临床分析[J]. 中国现代神经疾病杂志,2017,17(2):133-137
[26] Zhao Q,Yang X,Tian S,et al. Association of the COQ2V393A variant with risk of multiple system atrophy in East Asians:a case-control study and meta-analysis of the literature[J]. Neurol Sci,2016,37(3):423-430
[27] 杨百元,沈浩,钟伟,汪洋. 多系统萎缩患者的血尿酸与肌酐水平分析[J]. 中国实用神经疾病杂志,2016,19(23):67-69
[28] Chen D,Wei X,Zou J,et al. Contra-Directional Expression of Serum Homocysteine and Uric Acid as Important biomarkers of Multiple System Atrophy Severity:A Cross-Sectional Study[J]. Front Cell Neurosci,2015,6(9):247
[29] 张志叶,王莉. 治疗神经源性体位性低血压新药屈昔多巴[J]. 中国新药杂志,2015,24(19):2164-2166;2226
[30] Wenning GK,Geser F,Krismer F,et al. The natural history of multiple system atrophy:a prospective European cohort study[J]. Lancet Neurol,2013,12(3):264-274
[31] Constantinescu R,Richard I,Kurlan R. Levodopa responsiveness in disorders with parkinsonism:a review of the literature[J]. Mov Disord,2007,22(15):2141-2148
[32] Friess E,Kuempfel T,Modell S,et al. Paroxetine treatment improves motor symptoms in patients with multiple system atrophy[J]. Parkinsonism Relat Disord,2006,12(7):432-437
[33] 许玉珉,马云枝,沈晓明. 补肾归元法论治多系统萎缩临证探微[J]. 中医临床研究,2015,7(1):70-71
[34] 司维. 周绍华益气温阳法治疗多系统萎缩经验总结[J]. 中西医结合心脑血管病杂志,2016,14(6):669-671
[35] 于春霞. 补中益气汤加减治疗多系统萎缩19例疗效观察[J]. 新中医,2010,42(12):57-58
[36] 宁侠,毛丽军. 周绍华以益气温阳法治疗神经系统疾病经验[J]. 北京中医药,2012,31(2):96-99
[37] 徐昭,贾玉洁. 枕三经排刺法治疗多系统萎缩小脑型患者15例临床观察[J]. 中医杂志,2016,57(20):1764-1767
[38] 马涛,韩景献. 枕三经排刺法治疗恢复期小脑梗塞性眩晕32例[J]. 时珍国医国药,2008,19(3):731
[39] 虞定海. 中国传统保健体育与养生[M]. 上海:上海科学技术出版社,2001:234-267
[40] 韩平,梁杰,王晓玲,等. 八段锦改善老年人运动控制能力的作用机制分析[J]. 福建中医药,2015,46(1):1-2
[41] 刘晓云,尹兵祥. 八段锦运动疗法预防社区老年人跌倒的应用及效果[J]. 护理研究,2016,30(2):423-425
[42] 殷萱,姚斐,孙萍萍,等. 易筋经与核心稳定性训练的比较分析[J]. 上海中医药大学学报,2015,29(4):12-15
[43] 鄢晓枫. 六字诀和八段锦训练对慢性心力衰竭患者运动耐量的影响[J]. 中国中医药现代远程教育,2016,14(16):126-128
[44] 周国庆,姚新苗,李华,等. 六字诀与腰椎核心稳定性训练的内在联系[J]. 康复学报,2016,26(4):47-51
[45] 张瑞锋,殷竞争,周玉帅,等. 多系统萎缩患者皮肤组织中泛素和α-突触核蛋白的表达[J]. 郑州大学学报:医学版,2015,50(3):358-361
[46] 宫殿荣,于海燕,赵敏,等. 寰枕间隙侧方穿刺移植脐血单个核细胞治疗多系统萎缩的临床观察[J/CD]. 中华细胞与干细胞杂志:电子版,2016,6(2):115-120