乳糜泻增加神经与精神异常风险


  【24drs.com】January 7, 2010 — 一篇新研究显示,乳糜泻病患常会有偏头痛与腕隧道症候群(Carpal tunnel syndrome)。
  
  筛检经切片证实乳糜泻的72名病患之后,研究者报告指出,许多人有精神方面问题,35%的乳糜泻病患有忧郁、人格改变或精神病病史。
  
  研究作者指出,6%至10%的乳糜泻病患有非典型的神经表现。之前的研究认为,小脑性共济失调是最常见的症状,这篇新研究观察发现,6%的病患有小脑性共济失调,其它6%有前庭功能不良,整体而言,26%的病患经历过输入性共济失调。
  
  约三分之一的病患有站立与步态问题,许多人经历深度感觉丧失与减少脚踝反射。
  
  德国Marburg大学的Katrin Burk医师等研究者报告指出,乳糜泻的步态问题不只是因为小脑性共济失调,也可能因为本体感受或前庭缺损,即使严格遵守无麸质饮食,仍然有可能发生神经问题。
  
  该研究发表于12月15日的Movement Disorders期刊。
  
  【观察偏见】
  这72名乳糜泻病患是透过广告与使用一个标准问卷访谈后纳入。
  
  研究者指出,这领域中的研究多数聚焦在一线神经照护的病患,为了排除此类观察偏见,对经切片证实为乳糜泻的病患筛检神经疾病。
  
  约有三分之一(28%)乳糜泻病患报告有偏头痛病史,在许多案例中,导入无麸质饮食之后,偏头痛发作频率与强度都降低。
  
  约有20%的病患经历腕隧道症候群,研究者报告指出,令人惊讶的是,癫痫比预期的少,只有4个人出现大发作或局部发作。
  
  动作问题如基底核症状、椎状体路径症状、抽动与肌跃症较不常见,总共有14%的病患报告有膀胱功能不佳。
  
  【可能有多种机转】
  乳糜泻中,造成神经疾病的机转还不甚了解,缺乏叶酸、维他命E与生物喋呤(Biopterin )都对病理原因有所影响;不过,研究者报告指出,多数案例中,替代治疗无法缓解临床症状。
  
  研究者指出,维他命缺少症很少引起乳糜泻患者的明显异常,多数的神经症状并没有任何营养缺乏的证据。
  
  他们指出,乳糜泻的神经表现是引人注意的,必须认为不是偶发的,病患的无麸质饮食会缓解肠道症状,但是无法预防发生神经缺损。
  
  研究者认为,因为考量临床差异,有许多不同的病理机转可能会造成乳糜泻的神经和精神功能不佳。
  
  研究者皆宣告没有相关财务关系。
  
  Mov Disord. 2009;24:2358-2362.

Celiac Disease Increases Risk of Neurological and Psychiatric Disorders

By Allison Gandey
Medscape Medical News

January 7, 2010 — Migraine and carpal tunnel syndrome are common among celiac patients, a new study shows.

After screening a cohort of 72 patients with biopsy-proven celiac disease, researchers also report that many experience psychiatric problems, with 35% of celiac patients reporting a history of depression, personality changes, or psychosis.

Atypical neurological presentations are thought to occur in 6% to 10% of celiac patients, the study authors note. Prior studies have suggested that cerebellar ataxia is the most frequent symptom. This new study observed cerebellar ataxia in 6% of patients. Another 6% had vestibular dysfunction. In all, 26% of patients experienced afferent ataxia.

About a third of patients had stance and gait problems, and many experienced deep sensory loss and reduced ankle reflexes.

"Gait disturbances in celiac disease do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment," report investigators led by Katrin Burk, MD, from the University of Marburg in Germany. "Neurological problems may develop despite strict adherence to a gluten-free diet."

Neurological problems may develop despite strict adherence to a gluten-free diet.

The study is published in the December 15 issue of Movement Disorders.

The 72 patients with celiac disease were recruited through advertisements and interviewed using a standard questionnaire.

"Most studies in this field are focused on patients under primary neurological care," the researchers note. "To exclude such an observation bias, patients with biopsy-proven celiac disease were screened for neurological disease."

About a third of celiac patients (28%) reported a history of migraine. In many cases, there was a decrease in the frequency and intensity of migraine attacks after the introduction of a gluten-free diet.

About 20% of patients experienced carpal tunnel syndrome. "Surprisingly, epilepsy was less common than expected," report the researchers. "Only 4 individuals presented with a history of generalized or focal seizures."

Motor problems, such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus, were infrequent. A total of 14% of patients reported bladder dysfunction.

Multiple Mechanisms Likely

In celiac disease, the mechanisms leading to neurological disease are not yet understood. Deficiencies in folic acid, vitamin E, and biopterin have been implicated in the pathogenesis; however, the investigators report that replacement therapy does not resolve clinical symptoms in most cases.

The researchers point out that hypovitaminosis rarely causes overt abnormalities in celiac patients, and most with neurological symptoms do not show evidence of any nutritional deficiencies.

"The prevalence of neurological manifestations in celiac disease is striking and must be considered more than accidental," they note. "The patients' gluten-free diet had resolved intestinal symptoms but had not prevented the development of neurological deficits."

The investigators suggest that because of the considerable clinical variability, many different pathogenic mechanisms are likely to contribute to the neurological and psychiatric dysfunction in celiac disease.

The researchers have disclosed no relevant financial relationships.

Mov Disord. 2009;24:2358-2362.

    
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