PDF(2984 KB)
PDF(2984 KB)
PDF(2984 KB)
器官移植后运动障碍的临床诊治进展
Advances in clinical management of post-transplant movement disorders
运动障碍是实体器官移植后常见的神经系统并发症之一,具有多种临床表型,包括震颤、肌阵挛、舞蹈症等,显著影响患者的生活质量。实体器官移植后神经系统并发症的总体发生率较高,在不同类型的器官移植中存在差异。其中,肝移植术后神经系统并发症相对更为常见,这与肝性脑病等多种因素有关。实体器官移植后神经系统并发症的相关机制尚未完全阐明,可能与免疫抑制剂的神经毒性、代谢紊乱以及手术等因素相关。移植后运动障碍常合并多种症状,此时应积极寻找背后的病因,排除缺血缺氧性脑病、感染和脑卒中等可能。如运动障碍单独出现,应首先考虑药物如免疫抑制剂的神经毒性。治疗策略包括病因治疗(优化免疫抑制方案)与对症支持(如抗癫痫药物、氯硝西泮或肉毒素注射)。多数运动障碍通过及时干预往往能取得较好的疗效,预后较好。本综述聚焦肝、肾、心脏移植术后不自主运动的流行病学、发病机制、临床表型、合并症状、诊断及鉴别诊断、治疗及预后,以期为临床实践提供参考。
Movement disorders are one of common neurological complications following solid organ transplantation. They encompass various clinical manifestations, including tremor, myoclonus, and chorea, which significantly impact patients' quality of life. Neurological complications following solid organ transplantation are generally observed at a relatively high overall incidence, with variations across different types of organ transplants. Among these, neurological complications are relatively more common after liver transplantation, which is associated with multiple factors such as hepatic encephalopathy. Although the underlying mechanisms remain incompletely understood, these complications are thought to arise from neurotoxicity from immunosuppressive drugs, metabolic disturbances, and surgical factors. Post-transplant movement disorders often coexist with multiple symptoms, necessitating an active search for underlying causes, ruling out possibilities such as ischemic-hypoxic encephalopathy, infection, or stroke. If movement disorders occur in isolation, the neurotoxicity of medications, such as immunosuppressive agents, should be considered first. Treatment involves etiological management (optimizing the immunosuppressive regimen) and symptomatic therapy (such as antiepileptic drugs, clonazepam, or botulinum toxin injections). With timely intervention, most cases achieve favorable outcomes with a good prognosis. This review focuses on the epidemiology, clinical manifestations, associated symptoms, diagnosis and differential diagnosis, treatment, and prognosis of involuntary movements following liver, kidney, and heart transplantation, aiming to serve as a clinical reference.
Organ transplantation / Tremor / Myoclonus / Post-pump chorea
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