诊断学理论与实践

诊断学理论与实践 ›› 2018, Vol. 17 ›› Issue (04): 414-418.doi: 10.16150/j.1671-2870.2018.04.011

• 论著 • 上一篇    下一篇

2005年路易体痴呆诊断标准与2017年新版诊断标准的临床比较分析

孟洁1, 2, 崔诗爽2, 孟云霞1, 王刚2   

  1. 1.江苏省连云港市第一人民医院老年医学科,江苏 连云港 222000;
    2.上海交通大学医学院附属瑞金医院神经内科,上海 200025
  • 收稿日期:2018-06-13 出版日期:2018-08-25 发布日期:2018-08-25
  • 通讯作者: 王刚 E-mail: wg11424@rjh.com.cn
  • 基金资助:
    上海市教育委员会高峰-高原项目-研究型医师计划（20172001）; 国家临床重点专科资助项目（国卫办医函[2013]544号）

Comparative analysis of 2005 and 2017 version of diagnostic criteria for dementia with Lewy bodies

MENG Jie1,2, CUI Shishuang2, MENG Yunxia1, WANG Gang2   

  1. 1. Department of Gerontology, First People’s Hospital of Lianyungang, Jiangsu Province, Jiangsu Lianyungang 222000, China;;
    2. Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2018-06-13 Online:2018-08-25 Published:2018-08-25

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摘要： 目的：研究2017年新版路易体痴呆（dementia with Lewy bodies,DLB）指南的诊断要点、治疗、预后等,以期提高医师对DLB的关注和认识,使更多的DLB患者得到早期诊断、全程管理及综合治疗。方法：选取30例符合2005年DLB诊断标准的很可能的DLB患者,回顾性分析其临床特点、治疗等,并用2017年新版DLB诊断标准对其进行诊断。结果：根据2017年新版DLB诊断标准,30例患者中有27例被诊断为很可能的DLB,3例被诊断为可能的DLB;其中伴有帕金森症患者29例（96.7%）,波动性认知障碍的患者有16例（53.3%）;视幻觉患者25例（83.3%）;伴快速眼动期睡眠行为障碍（rapid eye movement sleep behavior disorder,RBD）症状患者11例（36.7%）。21例患者（70%）以帕金森症起病,有9例患者（30%）以认知障碍伴视幻觉起病。结论：2017新版诊断标准增加了快速眼动期睡眠行为障碍（多导睡眠图异常）及123I-间位碘代苄胍心肌闪烁扫描成像异常对于诊断路易体的权重,为早期识别和诊断路易体痴呆提供客观依据,有利于患者得到及时的管理及综合治疗,从而改善其预后。

关键词: 路易体痴呆, 2017诊断标准, 临床特点

Abstract: Objective: To understand and study the diagnostic criteria, treatment and prognosis of 2017 version of guideline for dementia with Lewy bodies (DLB) to elevate the understanding and recognition of DLB for having more patients to be diagnosed at early stage to receive whole-course management and comprehensive treatment. Methods: The clinical characteristics and treatment of 30 patients who met the 2005 version of diagnostic criteria for DLB were retrospectively analyzed and were diagnosed again using the 2017 version of diagnostic criteria for DLB. Results: According to the 2017 version of diagnostic criteria for DLB, 27 cases were diagnosed as probable DLB, 3 cases were diagnosed as possible DLB. There were 29 cases（96.7%） with Parkinson's syndrome, 16 cases（53.3%） with fluctuating cognitive impairment, 25 cases （83.3%） with visual hallucinations, 11 cases（36.7%） with REM sleep behavior disorder. There were 21 cases （70%） initiated with Parkinson's syndrome and 9 cases（30%）initiated with cognitive impairment and visual hallucinations. Conclusions: The 2017 version of diagnostic criteria for DLB increases the weight of REM sleep behavior disorder（polysomnographic abnormality） and abnormal 123iodine-MIBG myocardial scintigraphy, providing objective basis for the early recognition and diagnosis of DLB, and is beneficial for patients to receive early management and comprehensive treatment, thereby improving the prognosis of the disease.

Key words: Dementia with Lewy bodies, 2017 version of diagnostic criteria for dementia with Lewy bodies, Clinical characteristics

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