目的 提高以少见精神、神经症状为主要表现的血糖异常的诊治水平.方法 对我院收治的以少见精神、神经症状为主要表现的血糖异常9例的临床资料进行回顾性分析,并结合文献探讨发病机制、治疗及预后.结果 本组3例为低血糖所致精神、神经症状,表现为精神行为异常2例,局限性肢体抽搐1例；6例为高血糖所致精神、神经症状,表现为局限性肢体抽搐及一侧肢体不自主运动各2例,步态不稳伴排尿障碍及双小腿疼痛伴肌肉萎缩各1例.本组确诊为2型糖尿病7例(伴偏侧舞蹈症和抽搐各2例、伴脊髓损害和骨骼肌病变各1例)、原发性肝癌和胰岛素瘤各1例.经严格控制血糖及对症支持治疗后,7例预后良好,2例因原发疾病为肿瘤预后较差.结论 血糖异常所致少见精神、神经症状易误诊为神经科疾病,临床上对于血糖异常患者需仔细查明病因,以排除其他潜在疾病.%Objective To improve diagnosis and treatment of glucose abnormalities expressed as rare mental and neurological symptoms. Methods Clinical data of 9 patients with neurological and psychological symptoms as main manifestations of abnormal glucose level in our hospital were retrospectively analyzed, and the pathogenesis, treatment and prognosis were explored with related literatures. Results Among the 9 patients, neurological and psychiatric symptoms in 3 patients caused by hypoglycemia, and 2 patients suffered mental behavior disorder, 1 patient had localized limbs tics; neurological and psychiatric symptoms in 6 patients were caused by high blood glucose, 2 patients with partial limbs tics, 2 patients with one side limb involuntary movement, one with instability of gait and urination disorders, and one with pains in both legs and muscle atrophy. The diagnosis of type 2 diabetes was confirmed in 7 patients (2 patients with hemichorea, 2 with tics, 1 with spinal cord lesion, 1 with skeletal muscle lesion) , the other 2 with primary liver cancer or insulinoma respectively. After the strict control of blood sugar and corresponding treatment, 7 patients were of eusemia, and 2 patients were of poor prognosis due to primary disease of tumor. Conclusion RIoorl glucose abnormalities in spirit nervous system symptoms may easily be misdiagnosed as neurogenic disease, and clinicians should be more careful about those patients with abnormal blood glucose and find out the causes in order to exclude other potential disease.b
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