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126例Wilson’s病患者临床特点分析

Clinical Characteristics of Wilson’s Disease : a Retrospective Analysis of Admission Data among 126 Patients

  • 摘要: 目的 分析总结Wilson’s病(Wilson’s disease, WD)患者临床特点,减少误诊,改善患者预后 。 方法 回顾性分析2008年1月至2014年12月我院收治的126例WD患者临床资料(主要包括临床表现、头部及腹部影像学检查),并进行分析总结。 结果 126例WD患者中,男女比为75∶51,发病中位年龄21岁。10.3%(13/126)患者有WD家族史,87.3%(109/126)患者表现为神经精神系统症状,14.3%(18/126)患者以肝病为首发表现。126例WD患者血清铜蓝蛋白水平均低于200 mg/L,其中铜蓝蛋白水平低于100 mg/L 121例(96.0%);在接受头部MRI检查患者中,92.7%(102/110)有异常;在接受腹部影像学检查患者中,88.9%(97/109)有异常;98.3%(115/117)患者裂隙灯角膜K-F环检查阳性;1例患者肝脏组织穿刺罗丹宁染色阳性。从发病到确诊的时间3 d~19年,中位时间8个月,有20例(15.9%)患者曾经被误诊为其他系统疾病。 结论 WD临床表现多样,在出现神经系统症状患者伴或不伴肝脏损害时,或临床不明原因的肝功能损害患者,均应考虑到此病的可能性,应进一步检测铜代谢相关指标、角膜K-F环,甚至肝脏组织穿刺活检以鉴别。

     

    Abstract: Objective To investigate the clinical features of Wilson’s disease(WD) for the purpose of avoiding misdiagnosis and therefore improving the prognosis of this rare disease. Methods This study enrolled all the patients diagnosed as WD who were admitted to West China Hospital, Sichuan University from Jan 2008 to Dec 2014. Their clinical manifestations,head and abdominal images data were extracted and analyzed. Results There were a total of 126 patients of WD, male female ratio was 75∶51, median age was 21-years old. 10.3%(13/126) of them had family history, 87.3%(109/126) patients presented with neuropsychiatric symptoms, 14.3%(18/126) patients manifested as chronic liver disease. All patients had decreased serum ceruloplasmin level <200 mg/L, 121(96.9%) patients had serum ceruloplasmin level <100 mg/L. Magnetic resonance imaging and abdominal ultrasound detected structural abnormalities in 92.7%(102/110) and 88.9%(97/109) patients respectively. Kayser-Fleischer rings on slit-lamp ophthalmologic examination was found in 98.3%(115/117) patients. One patient underwent liver biopsy and the result of rhodanine stain was positive. The time from onset to diagnosis varied from 3 d to 19 years 〔(1.59±2.66) years〕. 20 (15.9%) patients were initially misdiagnosed. Conclusion The patients presenting with neurological signs or unexplained liver disease should be assessed carefully for WD. Serum ceruloplasmin, 24-h urinary copper, Kayser-Fleischer rings and sometimes even liver biopsy could be helpful for the diagnosis.

     

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