60例脊髓亚急性联合变性临床分析
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摘要
目的探讨脊髓亚急性联合变性(SCD)的病因、临床特征、诊断及治疗。方法对60例临床确诊SCD的患者的临床资料进行回顾性分析,分析患者神经系统损害与疾病病程、血清学检查之间有无相关性。结果 60例患者中49例维生素B_(12)水平降低,异常率为81.66%;红细胞水平降低者39例,异常率为65.00%;Hb降低者34例;神经功能损害程度与病程有相关性,病程与红细胞、Hb、MCV之间有相关性。肌电图检查阳性率为80.39%,MRI病灶多位于脊髓后索及侧索;83.7%的患者经维生素B_(12)治疗后临床症状得到了缓解。结论 SCD病程越长,神经系统功能障碍越严重,早期诊断和治疗非常重要。
Objective To investigate the etiology, clinical features, diagnosis and treatment of subacute combined degeneration(SCD) of the spinal cord. Methods The clinical data of 60 patients with clinically confirmed SCD were retrospectively analyzed, and to analyze whether there was any correlation between neurological damage and disease course,serological examination. Results Among the 60 patients, 49 patients had lower vitamin B_(12) levels, and the abnormal rate was 81.66%; the red blood cell level decreased of 39 cases, and the abnormal rate was 65.00%; the Hb decreased of 34 cases. The degree of neurological damage was related to the course of disease, and there was a correlation between the course and red blood cells, Hb, MCV. The positive rate of electromyography was 80.39%. MRI lesions were mostly located in the posterior cord and lateral cord of the spinal cord. And 83.7% of patients were relieved after treatment with vitamin B_(12). Conclusion The longer the duration of SCD, the more serious the dysfunction of the nervous system.Early diagnosis and treatment are very important.
Objective To investigate the etiology, clinical features, diagnosis and treatment of subacute combined degeneration(SCD) of the spinal cord. Methods The clinical data of 60 patients with clinically confirmed SCD were retrospectively analyzed, and to analyze whether there was any correlation between neurological damage and disease course,serological examination. Results Among the 60 patients, 49 patients had lower vitamin B_(12) levels, and the abnormal rate was 81.66%; the red blood cell level decreased of 39 cases, and the abnormal rate was 65.00%; the Hb decreased of 34 cases. The degree of neurological damage was related to the course of disease, and there was a correlation between the course and red blood cells, Hb, MCV. The positive rate of electromyography was 80.39%. MRI lesions were mostly located in the posterior cord and lateral cord of the spinal cord. And 83.7% of patients were relieved after treatment with vitamin B_(12). Conclusion The longer the duration of SCD, the more serious the dysfunction of the nervous system.Early diagnosis and treatment are very important.
引文
[1]李鹏鹏,赵斌,赵晓峰,等.脊髓亚急性联合变性临床研究进展[J].中华临床医师杂志(电子版),2016,(1):121-123.
[2]朱海兵,欧阳桂兰,余海.老年人脊髓亚急性联合变性的临床分析[J].中华老年心脑血管病杂志,2016,18(2):175-178.
[3]Sun HY,Lee JW,Park KS,et al.Spine MR imaging features of subacute combined degeneration patients[J].Eur Spine J,2014,23(5):1052-1058.
[4]Healton EB,Savage DG,Brust JC,et al.Neurologic aspects of cobalamin deficiency[J].Medicine(Baltimore),1991,70(4):229-245.
[5]王丽娟,顾淑娥,马艳茹,等.脊髓亚急性联合变性103例临床分析[J].临床荟萃,2016,31(4):411-413,417.
[6]张瑞云,武力勇,冯雪岩,等.内因子抗体和(或)抗胃壁细胞抗体阳性的脊髓亚急性联合变性8例分析[J].北京医学,2016,38(1):5-8.
[7]孙雪.脊髓亚急性联合变性的临床特点分析[J].中国实用神经疾病杂志,2015,(10):71-72.
[8]王智巍.脊髓亚急性联合变性56例临床分析[J].海军医学杂志,2017,38(5):479-480,封3.
[9]翟跃芬,王虎清,杜赟,等.脊髓亚急性联合变性患者血清维生素B12水平与临床表现的分析[J].中国临床神经科学,2017,25(1):31-38,48.
[10]张欣,刘西玲,刘玥.血清维生素B12及同型半胱氨酸检测在脊髓亚急性联合变性中的诊断价值[J].现代检验医学杂志,2017,32(4):43-46.
[11]李楠,王璐,王苏平.血清维生素B12水平正常的脊髓亚急性联合变性患者临床特点[J].山东医药,2018,58(4):74-76.
[12]金娟,李妍,朱皓月,等.脊髓亚急性联合变性患者临床神经损害相关因素及电生理特点分析[J].中国医科大学学报,2016,45(8):715-718.
[13]曾文双,童晓欣,苏曼.亚急性联合变性的神经电生理研究[J].癫痫与神经电生理学杂志,2016,25(1):12-14.
[14]张瑞云,刘岳阳,王辰龙.MRI正常的脊髓亚急性联合变性的临床特征分析[J].中国实用神经疾病杂志,2018,21(6):647-651.
[15]李璐,郭水洁,郭会利,等.磁共振对脊髓亚急性联合变性的诊断价值[J].医学影像学杂志,2018,28(4):583-586.
[16]孟闫凯,李江山,王敦敬,等.磁共振在脊髓亚急性联合变性诊断中的应用价值[J].中国CT和MRI杂志,2015,(1):25-26,35.
[17]张建国,刘晓伟.大剂量甲钴胺治疗脊髓亚急性联合变性40例临床分析[J].临床医学研究与实践,2018,3(8):36-37.
[2]朱海兵,欧阳桂兰,余海.老年人脊髓亚急性联合变性的临床分析[J].中华老年心脑血管病杂志,2016,18(2):175-178.
[3]Sun HY,Lee JW,Park KS,et al.Spine MR imaging features of subacute combined degeneration patients[J].Eur Spine J,2014,23(5):1052-1058.
[4]Healton EB,Savage DG,Brust JC,et al.Neurologic aspects of cobalamin deficiency[J].Medicine(Baltimore),1991,70(4):229-245.
[5]王丽娟,顾淑娥,马艳茹,等.脊髓亚急性联合变性103例临床分析[J].临床荟萃,2016,31(4):411-413,417.
[6]张瑞云,武力勇,冯雪岩,等.内因子抗体和(或)抗胃壁细胞抗体阳性的脊髓亚急性联合变性8例分析[J].北京医学,2016,38(1):5-8.
[7]孙雪.脊髓亚急性联合变性的临床特点分析[J].中国实用神经疾病杂志,2015,(10):71-72.
[8]王智巍.脊髓亚急性联合变性56例临床分析[J].海军医学杂志,2017,38(5):479-480,封3.
[9]翟跃芬,王虎清,杜赟,等.脊髓亚急性联合变性患者血清维生素B12水平与临床表现的分析[J].中国临床神经科学,2017,25(1):31-38,48.
[10]张欣,刘西玲,刘玥.血清维生素B12及同型半胱氨酸检测在脊髓亚急性联合变性中的诊断价值[J].现代检验医学杂志,2017,32(4):43-46.
[11]李楠,王璐,王苏平.血清维生素B12水平正常的脊髓亚急性联合变性患者临床特点[J].山东医药,2018,58(4):74-76.
[12]金娟,李妍,朱皓月,等.脊髓亚急性联合变性患者临床神经损害相关因素及电生理特点分析[J].中国医科大学学报,2016,45(8):715-718.
[13]曾文双,童晓欣,苏曼.亚急性联合变性的神经电生理研究[J].癫痫与神经电生理学杂志,2016,25(1):12-14.
[14]张瑞云,刘岳阳,王辰龙.MRI正常的脊髓亚急性联合变性的临床特征分析[J].中国实用神经疾病杂志,2018,21(6):647-651.
[15]李璐,郭水洁,郭会利,等.磁共振对脊髓亚急性联合变性的诊断价值[J].医学影像学杂志,2018,28(4):583-586.
[16]孟闫凯,李江山,王敦敬,等.磁共振在脊髓亚急性联合变性诊断中的应用价值[J].中国CT和MRI杂志,2015,(1):25-26,35.
[17]张建国,刘晓伟.大剂量甲钴胺治疗脊髓亚急性联合变性40例临床分析[J].临床医学研究与实践,2018,3(8):36-37.