复发性Tolosa-Hunt综合征临床分析

摘要

目的：分析复发性Tolosa-Hunt综合征（THS）的临床特征、复发特点。方法收集24例2006年1月至2016年5月确诊的复发性THS患者的临床资料。对其一般特征、临床表现、病程及复发特征、实验室及影像学检查、治疗转归等进行分析，并与同期69例初发性THS患者的临床资料进行比较。结果复发性THS占THS总数的25.8%（24/93）。复发组男性比例显著高于初发组[66.7%（16/24）比42.0%（29/69）]，差异有统计学意义（P＜0.05）；复发组三叉神经第一支受累率低于初发组[16.7%（4/24）比33.0%（23/69）]，差异有统计学意义（P＜0.05）；复发组总病程3个月至20年，总复发次数2～10次，同侧复发18例，对侧复发6例，平均复发间隔1.9年（3个月至6年），2例在激素减量时复发，22例在激素停用时复发。24例患者均接受MRI检查，其中19例（79.2%）显示海绵窦受累，单侧受累16例，双侧受累3例；复发后激素治疗仍有效。结论 THS具有一定的复发性，少数患者复发频繁，复发周期差异较大，可为数个月至数年，易于在同侧，也可在海绵窦两侧交替复发。复发症状常较初发者轻，男性患者及未经激素规律治疗者可能更易复发，复发性THS对激素治疗仍有良好的反应。%Objective To analyze the clinical features, recurrent characters in patients with recurrent Tolosa-Hunt syndrome (THS). Methods The clinical data of 24 hospitalized patients with recurrent THS from January 2006 to May 2016 were collected The general features, clinical manifestations, disease courses, recurrent features, lab and imaging studies, treatment measures and outcoming of recurrent THS patients was investigated , and compared with 69 patients with first attack THS in corresponding period. Results Recurrent THS patients were 25.8%(24/93) of total THS. The male rate in recurrent group was significantly higher than that in first attack group: 66.7%(16/24) vs. 42.0%(29/69), P<0.05. The involved rate of trigeminal nerves in recurrent group was significantly lower than that in first attack group:16.7%(4/24) vs. 33.0%(23/69), P<0.05. The disease courses were from 3 months to 20 years. The total recurrent frequencies were from 2 to 10 times. The recurrence occurred in the same side in 18 patients, and in contralateral in other 6 patients. The intervals were from 3 months to 6 years, and average intervals were 1.9 years. Two patients recurred in hormone reduction, and 22 patients recurred in hormone withdrawal. All cases received MRI examination. Nineteen patients (79.2%) of them had lesions in cavernous sinus. 16 patients had one side lesions and 3 patients had bilateral lesions. The recurrent patients still had good responds to corticosteroids treatment. Conclusions Recurrences in THS are common, taking place in about 26%total patients, and usually at an interval of months or years from the initial attack. These recurrences may be ipsilateral, contralateral, or rarely, bilateral. Corticosteroids are still effective to recurrent cases.