帕金森综合症
| 帕金森综合症 Parkinsonism | |
|---|---|
 | |
| 病因 | |
| 分类和外部资源 | |
| 医学专科 | 神经学 |
| ICD-11 | 8A00 |
| ICD-10 | G21、G22 |
| DiseasesDB | 24212 |
| MedlinePlus | 000759 |
| Orphanet | 68402 |
帕金森综合症（Parkinsonism）是和运动机能相关的临床综合症，其特征是颤抖、运动功能减退、僵硬及平衡障碍[1][2]。在帕金森氏症（PD）患者身上会有类似症状（此综合症因此而得名），而路易氏体痴呆症（DLB）、帕金森病性痴呆症（PDD）等疾病也会有此症状。这类综合症的病因范围很广，包括神经退化障碍疾病、药物、毒素、代谢疾病，或是帕金森氏症以外的神经性疾病[3]。
病因
[编辑]药物引起
[编辑]有帕金森综合症的人当中，约有7%是因为药物的副作用而造成的，主要是因为抗精神病药，特别是吩噻嗪（例如perphenazine及氯丙嗪）、噻吨（例如三氟噻吨及珠氯噻醇）及丁酰苯（例如氟哌啶醇），偶尔也有因为抗忧郁药物而造成。药物引起帕金森综合症的盛行率会随年龄而上升。药物引起的帕金森综合症一但出现，多半会维持原有的程度，不像帕金森氏症会渐渐恶化[4]。
毒素
[编辑]有发现杀虫剂或除草剂暴露程度和帕金森氏症之间的关联性。若暴露在百草枯或锰乃浦/锌锰乃浦下，风险是原来的两倍[5]。
已证实慢性锰（Mn）暴露会造成类似帕金森综合症的疾病，其特征是运动障碍，此症状无法用典型的帕金森症治疗方式来治疗，因此推测除了典型黑质内多巴胺能损失外，包括有其他的致病途径[6]。锰会在基底核内累积，因此造成运动障碍[7]有一种和SLC30A10基因（锰外流转运蛋白，减少细胞内锰所必需的蛋白）有关的变异和这种类似帕金森综合症疾病有关[8]。在这疾病中看不到帕金森氏症中典型的路易体[7]。
诊断
[编辑]许多疾病会造成帕金森综合症。
- 皮质基底核退化症[9]
- 路易氏体痴呆症[9]
- 额颞痴呆症（匹克氏病）[10]
- 格斯特曼–斯特劳斯勒–申克综合症[9]
- 亨丁顿舞蹈症[9]
- Lytico-bodig症（ALS complex of Guam）[9]
- 多系统萎缩（Shy–Drager综合症）[9]
- 神经吞噬作用[9]
- 神经元蜡样脂褐质储积症[9]
- 少脑桥小脑萎缩[9]
- 泛酸盐激活酵素关联之神经退化性疾病，也称为具有脑部铁质积聚的神经变性（neurodegeneration with brain iron accumulation）[9]
- 帕金突变（遗传性青少年肌张力障碍）[9]
- 帕金森氏症[9]
- 帕金森氏症性痴呆症[11]
- 进行性上眼神经核麻痹症[9]
- 肝豆状核变性[9]
- X连锁性肌张力障碍帕金森症（Lubag综合症）[9]
- 药物引发（伪帕金森综合症）
- 感染
- 毒素
- 番荔枝科[16]
- 一氧化碳[9]
- 二硫化碳[9]
- 氰化物[9]
- 乙醇[9]
- 己烷[17]
- 锰乃浦/锌锰乃浦[5]
- 锰[9][6]
- 汞[9]
- 甲醇[9]
- MPTP[9][18]
- 百草枯[19][5]
- 鱼藤酮[19]
- 甲苯[20]（吸入滥用）[21]
- 创伤
- 血管的
- Binswanger病（皮质下白质脑病）[9]
- 血管性痴呆症（多发梗死性）[9]
- 其他
- 脑干受损（特别是黑质的多巴胺能核）[22][23]或是基底核（特别是苍白球）[24]或丘脑的受损[25]
- 甲状腺机能低下症[9]
- 站立性颤抖症[26]
- 肿瘤伴随综合症：因为癌症产生的抗体引发的神经性症状[27]
- 快速发作的肌张力障碍性帕金森病[28]
- 常染色体隐性遗传性少年帕金森病[29]
原发性震颤
[编辑]根据2018年的回顾性研究，还不确定帕金森综合症和原发性震颤是否有关[30]。
参考资料
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