查看“舞蹈症”的源代码

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            <strong>[[舞蹈症]] (Chorea)</strong> 源自希腊语 "choreia"（意为舞蹈），是一种常见的<strong>[[运动过多性障碍]] (Hyperkinetic Disorder)</strong>。其临床特征为身体某一部位（常为四肢远端、面部）发生不自主、无规律、短暂且快速的跳动样动作，这些动作往往在无预警的情况下随机出现，并可能从一个部位游走到另一个部位。患者常试图将这些异常动作掩饰为正常的随意动作（如整理头发）。舞蹈症并非一种独立的疾病，而是一组由<strong>[[基底节]]</strong>（特别是<strong>[[纹状体]]</strong>）功能障碍引起的临床综合征，可见于 <strong>[[亨廷顿舞蹈症]]</strong>、<strong>[[小舞蹈病]]</strong>、脑血管病及药物副作用等多种病理状态。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">舞蹈症</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">Chorea · 点击展开</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">核心特征：不自主、无规律</div>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 40%;">ICD-11 编码</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">8A01</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">病变定位</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[纹状体]] (尾状核/壳核)</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">常见病因</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[亨廷顿病]] / [[风湿热]] / SLE</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">典型体征</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[挤奶妇手法]] / 琴师指</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">药物诱发</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[左旋多巴]] / 避孕药</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569;">首选对症药</th>
                    <td style="padding: 8px 12px; color: #1e40af;">[[丁苯那嗪]]</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">神经病理机制：刹车失灵</h2>
    
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        舞蹈症的产生主要源于<strong>[[基底节]]</strong>（Basal Ganglia）神经环路的失衡，特别是间接通路的受损：
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        <li style="margin-bottom: 12px;"><strong>纹状体神经元丢失：</strong> 在亨廷顿舞蹈症中，纹状体（Striatum）中投射到苍白球外侧部（GPe）的 GABA 能中型多棘神经元（MSN）率先死亡。</li>
        <li style="margin-bottom: 12px;"><strong>去抑制效应：</strong> 间接通路的抑制减弱，导致 GPe 对底丘脑核（STN）的抑制解除，STN 活性异常进而扰乱了输出核团（GPi/SNr）。</li>
        <li style="margin-bottom: 12px;"><strong>丘脑过度激活：</strong> 最终结果是基底节对丘脑的抑制性输出减少，丘脑-皮层环路过度兴奋，导致运动皮层发出多余的、不受控制的运动指令。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">病因分类：从遗传到获得性</h2>

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                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 20%;">分类</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">代表性疾病/原因</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">临床特点</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">遗传性</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>[[亨廷顿舞蹈症]] (HD)</strong><br>[[神经棘红细胞增多症]]<br>[[良性遗传性舞蹈病]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">常伴有认知障碍（痴呆）和精神症状；家族史阳性。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">免疫/感染性</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>[[小舞蹈病]] (Sydenham Chorea)</strong><br>[[系统性红斑狼疮]] (SLE)<br>[[抗磷脂综合征]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">小舞蹈病多见于儿童，链球菌感染后发生；SLE 患者可能有血管炎改变。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">药物/代谢性</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">左旋多巴诱导的异动症<br>迟发性运动障碍 (TD)<br>妊娠舞蹈病</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">帕金森患者“开”期高峰剂量时出现；长期服用抗精神病药后出现。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">血管性</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">基底节脑梗死或出血</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">通常为<strong>[[偏侧舞蹈症]]</strong> (Hemichorea)，急性起病。</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">特征性体征：医生的观察点</h2>
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        除了明显的舞蹈样动作，体格检查中常可见以下特有征象：
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        <li style="margin-bottom: 12px;"><strong>挤奶妇手法 (Milkmaid's Grip)：</strong> 当患者用力握住检查者的手指时，握力无法持续恒定，表现为一松一紧，如同挤牛奶的动作。</li>
        <li style="margin-bottom: 12px;"><strong>玩偶眼征消失：</strong> 转头时眼球无法固定注视点。</li>
        <li style="margin-bottom: 12px;"><strong>舌头伸缩征 (Jack-in-the-box Tongue)：</strong> 要求患者伸舌并维持时，舌头会无法控制地反复伸出缩回。</li>
        <li style="margin-bottom: 12px;"><strong>钢琴指 (Piano-playing Fingers)：</strong> 双手平举时，手指出现不自主的屈伸波动，形似弹钢琴。</li>
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            <li style="margin-bottom: 8px;"><strong>[[手足徐动症]] (Athetosis)：</strong> 与舞蹈症类似但速度较慢，呈扭曲样、虫爬样，常涉及肢体远端。两者常并存称为“舞蹈手足徐动症”。</li>
            <li style="margin-bottom: 8px;"><strong>[[偏身投掷症]] (Hemiballismus)：</strong> 比舞蹈症更剧烈、幅度更大的甩动样动作，通常由<strong>[[底丘脑核]] (STN)</strong> 损伤引起。</li>
            <li style="margin-bottom: 8px;"><strong>[[VMAT2抑制剂]]：</strong> 治疗舞蹈症的一线药物，通过耗竭突触前膜的多巴胺来减少运动过多。</li>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评 [Academic Review]</span>
        
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            [1] <strong>Cardoso F, et al. (2006).</strong> <em>Seminar on choreas.</em> <strong>[[The Lancet Neurology]]</strong>. 5(7):589-602.<br>
            <span style="color: #475569;">[权威点评]：该综述系统地分类了舞蹈症的病因，并提供了详细的鉴别诊断流程图，是神经内科医师的案头必备。</span>
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            [2] <strong>Walker RH. (2007).</strong> <em>Differential diagnosis of chorea.</em> <strong>[[Current Neurology and Neuroscience Reports]]</strong>. 7(4):283-291.<br>
            <span style="color: #475569;">[学术点评]：重点讨论了除亨廷顿病以外的罕见舞蹈症病因，特别是神经棘红细胞增多症等代谢性原因的识别。</span>
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            [3] <strong>Jankovic J. (2009).</strong> <em>Treatment of hyperkinetic movement disorders.</em> <strong>[[The Lancet Neurology]]</strong>. 8(9):844-856.<br>
            <span style="color: #475569;">[学术点评]：权威的治疗指南，详细评估了多巴胺受体阻滞剂和 VMAT2 抑制剂在治疗舞蹈症中的疗效与安全性平衡。</span>
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            舞蹈症 · 知识图谱
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                <td style="width: 95px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">解剖基础</td>
                <td style="padding: 10px 15px; color: #334155;">[[基底节]]•[[纹状体]]•[[底丘脑核]]•[[GABA能神经元]]</td>
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                <td style="width: 95px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">关联疾病</td>
                <td style="padding: 10px 15px; color: #334155;">[[亨廷顿病]]•[[小舞蹈病]]•[[Wilson病]]•[[红斑狼疮]]</td>
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                <td style="width: 95px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">治疗药物</td>
                <td style="padding: 10px 15px; color: #334155;">[[丁苯那嗪]]•[[氟哌啶醇]]•[[氯氮平]]•[[金刚烷胺]]</td>
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                <td style="width: 95px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">鉴别症状</td>
                <td style="padding: 10px 15px; color: #334155;">[[震颤]]•[[肌张力障碍]]•[[抽动秽语综合征]]•[[肌阵挛]]</td>
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