摘要： 目的 探讨桥本脑病临床特点，提高诊断与治疗水平。方法与结果 对22 例桥本脑病患者的临床表现、实验室和影像学特点、治疗及预后进行回顾分析，临床主要表现为急性或亚急性发病的认知功能障碍（9 例）、精神症状（6 例）、癫痫发作（5 例）、共济失调（5 例）、卒中样发作（6 例）、锥体外系症状（3 例）和意识障碍（3 例），且血清抗甲状腺过氧化物酶抗体（19 例）和抗甲状腺球蛋白抗体（20 例）水平明显升高。其中21 例经糖皮质激素冲击治疗，17 例病情不同程度改善。结论 桥本脑病是一种伴抗甲状腺抗体水平升高的脑病，大多数患者对糖皮质激素冲击治疗反应良好，早期诊断、及时治疗对改善患者预后尤为重要。对于不明原因的脑病患者，应考虑桥本脑病的可能，推荐血清抗甲状腺抗体作为常规实验室检查项目。

关键词: 甲状腺炎, 自身免疫性, 脑疾病, 碘化物过氧化物酶, 甲状腺球蛋白, 糖皮质激素类

Abstract: Objective  To investigate the clinical presentations of Hashimoto's encephalopathy (HE), so as to improve the diagnosis and treatment of this disease. Methods  A retrospective analysis was performed on clinical features, laboratory findings, imaging profiles, treatment and outcomes of 22 patients with HE who were admitted to our hospital between June 2010 and September 2013.  Results  Clinical symptoms were mainly acute or subacute cognitive impairment (9 cases), psychiatric symptoms (6 cases), seizures (5 cases), ataxia (5 cases), stroke-like episodes (6 cases), tremor (1 case), myoclonus (2 cases) and disturbance of consciousness (3 cases). Marked increase was found in serum anti-thyroid peroxidase (anti-TPO) antibody level (19 cases) and anti-thyroglobulin (anti-TG) antibody level (20 cases). Twenty-one cases were treated with glucocorticoids, and one patient was treated only with general neurotrophic therapy, such as ganglioside. Except for 4 cases showed bad response to steroids, the rest patients had an obvious improvement. Conclusions  Hashimoto's encephalopathy is an encephalopathy with the presence of elevated antithyroid antibodies, and most patients showed good response to steroids. So early diagnosis and treatment is particularly important for improving prognosis. This disease should be considered as an important differential diagnosis for encephalopathy of unknown etiology, and screening for serum antithyroid antibodies should be performed as initial screening test.

Key words: Thyroiditis, autoimmune, Brain diseases, Iodide peroxidase, Thyroglobulin, Glucocorticoids