摘要
目的探索胰岛素瘤累及神经系统损害的临床规律。方法回顾性分析累及神经系统损害的胰岛素瘤患者的临床表现。结果 16例胰岛素瘤患者发作时最低血糖<2.78 mmol·L-1(50 mg·dL-1)。影像学检出胰腺肿块15例,剖腹探查发现肿瘤1例。经病理证实胰岛素瘤后根据患者神经系统损害表现分为5型:癫型8例、脑卒中型3例、周围神经损害型1例、自主神经发作型3例和多系统损害型1例。胰岛素瘤累及神经系统损害患者的临床表现规律为:各种临床类型中以癫最为多见,多在清晨或半夜发病;出现其他神经系统损害者(包括脑血管疾病、慢性周围神经病、痴呆等)多伴发癫。提出伴发神经系统损害胰岛素瘤的诊断标准:①成人临晨或午夜反复发生癫和(或)短暂脑缺血性发作样表现。②病程中出现慢性进行性周围神经或认知障碍、共济失调、锥体系、锥体外系等损害。③空腹血糖低于正常值或甲磺丁脲试验阳性。④腹部CT、MRI、B型超声检查、PET检查或剖腹探查发现胰腺肿块。⑤胰腺肿块病理示胰岛素瘤。具有上述①或②,③中2项者为提示诊断。具有上述①或②,③,④中3项者为可能诊断。上述两类诊断最终具备⑤者为确诊诊断。结论依据16例胰岛素瘤病例临床特征分析和复习文献资料,提出伴发神经系统损害的胰岛素瘤的诊断标准供临床参考。
Aim To explore the clinical characteristics ofinsulinoma with neurological injury.Methods 16 insulinoma cases with neurological injury were analyzed by clinical manifestations.Results All medical records of the patients with histopathologically identified insulinoma were reviewed.According to the clinical symptoms,16 cases were divided into 5 types,8 cases of epilepsy,3 cases of stroke,one case of peripheral lesion,3 cases of autonomic nervous system discharge and one case of multi-systemic lesion.One pattern was found that epilepsy was one of the most common manifestations among the different clinical types,and its onset was usually in the morning or at midnight.While other neurological damage often occurred with epilepsy,including cerebrovascular disease,chronic peripheral neuropathy,dementia,etc.The lowest blood glucose level of all the patients was below 2.78 mmol·L-1 （50 mg·dL-1） during monitored symptomatic episodes.Pancreatic mass were found in 15 cases by imaging examination,and tumor was found in one case through exploratory laparotomy.Conclusion The data from this experiment can be used as a clinicians＇ reference for the diagnostic criteria for insulinoma involving neurological impairment.
出处
《中国临床神经科学》
2014年第3期276-281,共6页
Chinese Journal of Clinical Neurosciences
