摘要
目的分析脊髓亚急性联合变性患者的临床表现、病史、电生理检查结果、影像学检查、实验室检查结果、治疗方法及病情转归情况。方法回顾性分析2016年4月—2021年4月福建医科大学省立临床医学院/福建省立医院神经内科收治的40例脊髓亚急性联合变性患者的临床资料,根据患者病程分为短病程组18例(病程≤6个月)、长病程组22例(病程>6个月);随访6个月,比较入院时、随访6个月时患者的神经功能缺损评分变化情况。根据检查结果、随访结果分析患者的临床特征。结果(1)脊髓亚急性联合变性患者多伴有慢性胃炎,病情进展缓慢;(2)主要表现包括贫血、下肢感觉异常、感觉共济失调、痉挛性瘫痪等;(3)实验室检查显示维生素B12水平明显降低,患者有不同程度贫血;电生理检查显示体感诱发电位、肌电图异常率较高;核磁共振检查脊髓病变多数呈矢状位条索状T2高信号,有“倒V征”,轴位部分病灶可强化。(4)患者主要采用大剂量维生素B12进行治疗,积极治疗贫血、胃炎等原发疾病。治疗3~6个月后,40例患者总有效率为90.00%;(5)随访6个月时,患者的神经功能缺损评分均低于入院时,差异有统计学意义(P<0.05)。(6)长病程组同型半胱氨酸(homocysteine,Hcy)水平升高率、维生素B12降低率均低于短病程组,差异有统计学意义(P<0.05)。结论脊髓亚急性联合变性患者起病症状隐匿,呈慢性进行性发展,累及脊髓及周围神经,临床表现复杂。有典型的“倒V征”影像学特征,结合实验室检查、电生理检查等辅助检查可排除铜缺乏性脊髓病、视神经脊髓炎、多发性硬化等疾病。尽早确诊,给予维生素B12、叶酸等药物进行对症治疗可改善患者预后。
Objective To analyze the clinical manifestations,history,electrophysiological examination,imaging examination,laboratory examination,treatment and outcome of patients with subacute combined degeneration of spinal cord.Methods The clinical data of 40 patients with subacute combined spinal cord degeneration admitted to the department of internal neurology of Provincial College of Clinical Medicine,Fujian Medical University/Fujian Provincial Hospital from April 2016 to April 2021 were retrospectively analyzed.According to the course of disease,the patients were divided into the short course group(the course of disease no more than 6 months)(n=18)and the long course group(the course of disease more than 6 months)(n=22).The patients were followed up for 6 months,and the changes of neurological dysfunction scores at admission and 6 months were compared.The clinical characteristics of the patients were analyzed according to the examination results and follow-up results.Results(1)Patients with subacute combined degeneration of spinal cord were often accompanied by chronic gastritis and the disease progressed slowly.(2)The main manifestations include anemia,lower limb paresthesia,sensory ataxia,spastic paralysis,etc.(3)Laboratory tests showed a significant decrease in vitamin B12 levels,and the patient had varying degrees of anemia;electrophysiological examination showed that somatosensory evoked potential and electromyogram abnormality rate were higher.In MRI examination,most myelopathy showed sagittal cord T2 hyperintensity,with“inverted V sign”,and some lesions could be enhanced in axial position.(4)Patients were mainly treated with large doses of vitamin B12 and actively treated with anemia,gastritis and other primary diseases.After 3~6 months of treatment,the total effective rate of 40 patients was 90.00%.(5)At 6-month follow-up,the neurological dysfunction scores of the patients were lower than those at admission,with statistical significance(P<0.05).(6)The neurological dysfunction score,the increase rate of hom
作者
陈莹
陈牧野
吴梦倩
张旭
CHEN Ying;CHEN Muye;WU Mengqian;ZHANG Xu(Department of Internal Medicine Neurology,Provincial College of Clinical Medicine,Fujian Medical University/Fujian Provincial Hospital,Fuzhou Fujian 350000,China)
出处
《中国卫生标准管理》
2022年第11期48-51,共4页
China Health Standard Management
关键词
临床特征
脊髓亚急性联合变性
检查结果
治疗方法
病史
转归
clinical features
subacute combined degeneration of spinal cord
inspection results
treatment methods
history
outcome
