Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France-Sud, APHP-centre, Université de Paris, France; Université de Paris, F-75015, Paris, France.
Hôpital Cognaq-Jay, Service de Nutrition, Paris, France.
Clin Nutr. 2022 Jan;41(1):33-39. doi: 10.1016/j.clnu.2021.10.021. Epub 2021 Nov 11.
Acute thiamine deficiency can occur in patients with or without history of alcohol abuse and can lead to life-threatening complications. Clinical diagnosis is challenging, often resulting in delayed recognition and treatment. Patients may present with heterogenous symptoms, more diverse than the historical neurological description. Cerebral MRI can contribute to the diagnosis in patients with neurological signs but it is not always feasible in emergency settings. Prompt parenteral supplementation is required to obtain the improvement of symptoms and avoid chronic complications.
To describe the clinical presentation of reported cases of thiamine deficiency, assess prescription and results of cerebral imaging, review treatments that had been prescribed in accordance or not with available guidelines, and study the short-term outcome of these patients.
This is a monocentric retrospective analysis of all reported cases of thiamine deficiency in a French tertiary hospital between January 1st 2008 and December 31st 2018.
Fifty-six cases were identified during the study period. Forty-five (80%) patients had a history of alcohol abuse. Most patients were diagnosed based on neurological symptoms but non-specific and digestive symptoms were frequent. Thirty-four percent of patients fulfilled clinical criteria for malnutrition. A brain MRI was performed in 54% of patients and was abnormal in 63% of these cases. Eighty-five percent of patients were treated by parenteral thiamine administration and the supplementation was continued orally in 55% of them. The majority of patients initially received 1000 mg daily of IV thiamine but the dose and duration of thiamine supplementation were variable. At the time of discharge, partial or complete improvement of symptoms was noted in 59% of patients.
This study highlights the clinical and radiological heterogeneity of thiamine deficiency. These observations should encourage starting thiamine supplementation early in patients with risk factors or suggestive symptoms even in non-alcoholic patients, and underline the importance of early nutritional support.
急性硫胺素缺乏可发生于有或无酒精滥用史的患者，可导致危及生命的并发症。临床诊断具有挑战性，常导致识别和治疗延迟。患者可能表现出异质性症状，比历史上的神经描述更为多样化。对于有神经体征的患者，脑部 MRI 有助于诊断，但在紧急情况下并非总是可行。需要及时进行肠外补充，以改善症状并避免慢性并发症。
描述已报道的硫胺素缺乏病例的临床表现，评估脑影像学检查的处方和结果，回顾与现有指南相符或不符的治疗方法，并研究这些患者的短期预后。
这是对法国一家三级医院在 2008 年 1 月 1 日至 2018 年 12 月 31 日期间报告的所有硫胺素缺乏病例进行的单中心回顾性分析。
在研究期间共发现 56 例病例。45 例（80%）患者有酒精滥用史。大多数患者基于神经症状诊断，但非特异性和消化系统症状也很常见。34%的患者符合营养不良的临床标准。54%的患者进行了脑部 MRI 检查，其中 63%的病例异常。85%的患者接受了肠外硫胺素治疗，其中 55%的患者继续口服补充。大多数患者最初接受 1000mg/d 的 IV 硫胺素治疗，但硫胺素补充的剂量和持续时间各不相同。在出院时，59%的患者症状部分或完全改善。
本研究强调了硫胺素缺乏的临床表现和影像学异质性。这些观察结果应鼓励在有危险因素或提示性症状的患者中尽早开始补充硫胺素，即使是非酒精性患者，也应强调早期营养支持的重要性。
