背景:韦尼克脑病(WE)是一种严重的神经系统疾病,未被诊断。尽管临床指南有限,静脉(IV)硫胺素的标准使用未得到充分利用,仍然是值得关注的研究领域。
目的:我们使用Medline进行了系统评价,Embase,和CENTRAL数据库,以鉴定和总结WE中IV硫胺素治疗的文献。对接受≥100mg硫胺素IV的WE患者的人体研究符合纳入标准。随机对照试验,横断面研究,并纳入病例报告。
结果:共纳入27项研究:20例病例报告,五项回顾性研究,一项前瞻性研究和一项随机对照试验。在病例报告中,11例(55%)为女性,所有病例的平均年龄为45岁(SD=15)。其他7项研究包括688例患者;平均年龄为52岁(SD=9),266名(38.7%)为女性。在病例报告中,在16例(80%)病例中,使用神经和临床表现诊断WE.MRI用于诊断15例(75%)。在12例病例报告中报告了500mg静脉注射硫胺素TID(60%)。18例(90%)的病例报告在静脉注射硫胺素后症状部分或完全缓解。
结论:IV硫胺素可以缓解神经系统症状,认知功能障碍,和与WE相关的脑成像病变。我们发现静脉硫胺素的证据和WE的诊断标准存在关键局限性。未来的针对性研究应为WE建立明确的诊断和治疗指南,以防止这种严重的疾病被诊断不足或治疗不足。
Wernicke\'s encephalopathy (WE) is a serious neurological disorder that is underdiagnosed. Despite limited clinical guidelines, the standard use of intravenous (IV) thiamine is underutilized and remains an area of research deserving much attention.
We conducted a systematic review using Medline, Embase, and CENTRAL databases to identify and summarize the literature on IV thiamine treatment in WE. Human studies with WE patients who received ≥100 mg of thiamine IV met inclusion criteria. Randomized controlled trials, cross-sectional studies, and case reports were included.
A total of 27 studies were included: 20 case reports, five retrospective studies, one prospective study and one randomized control trial. Of the case reports, 11 (55%) cases were female, and the average age of all cases was 45 years (SD = 15). The other seven studies included 688 patients; the average age was 52 years (SD = 9), and 266 (38.7%) were female. Among the case reports, neurological and clinical findings were used to diagnose WE in 16 (80%) cases. MRI was utilized to diagnose 15 (75%) cases. 500 mg IV thiamine TID was reported in 12 case reports (60%). 18 (90%) of case reports had partial or complete resolution of symptoms following IV thiamine.
IV thiamine can alleviate neurological symptoms, cognitive dysfunction, and brain imaging lesions associated with WE. We found key limitations in the evidence for IV thiamine and diagnostic standards for WE. Future targeted research should establish clear diagnostic and treatment guidelines for WE to prevent this serious condition from being underdiagnosed or undertreated.