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
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摘要
目的探讨内因子抗体和,或抗胃壁细胞抗体对脊髓亚急性联合变性(Subacute combined degeneration of spinal cord,SCD)的诊断价值。方法回顾性分析宣武医院2014年8月至2015年1月收治的8例内因子抗体和(或)抗胃壁细胞抗体阳性患者的临床资料、血清维生素B_(12)、血红蛋白和血同型半胱氨酸、神经电生理及影像学资料结果。结果 8例患者均为亚急性或慢性起病,进行性加重,仅有3例出现了典型的脊髓后索、侧索和周围神经均受累的体征;血清维生素B_(12)低于正常者5例;血红蛋白低于正常者2例;同型半胱氨酸高于正常者4例。4例患者行肌电图神经传导速度检查,均提示肢体周围神经损害;脑脊髓MRI异常者4例。内因子抗体及抗胃壁细胞抗体均阳性者3例,仅内因子抗体阳性者3例,仅抗胃壁细胞抗体阳性者2例。8例患者均给予维生素B_(12)1000μg/d肌肉注射,1个月后对其进行随访,症状均有不同程度好转。结论有不完全脊髓后索、侧索、周围神经受累表现的患者,应该考虑到SCD可能,即便是脊髓影像学和血清维生素B_(12)水平正常,也应该进行血内因子抗体和抗胃壁细胞抗体检查。内因子抗体和(或)抗胃壁细胞抗体阳性SCD患者需要长期肌肉注射维生素B_(12)进行治疗。
Objective To analyze the clinical features of subacute combined degeneration(SCD) of spinal cord with positive antibodies against intrinsic factor and/or parietal cell, and to evaluate the diagnostic value of these two antibodies for SCD. Methods The clinical features of eight patients with SCD with positive antibodies against intrinsic factor and/or parietal cells were retrospectively analyzed. The clinical data reviewed include demographic information, serum level of vitamin B_(12), hemoglobin and homocysteine, as well as neurophysiological scores and MRI imaging findings. Results Eight SCD patients enrolled in this study were subacute or chronic in disease onset, and deteriorated progressively.Only three patients presented with the combination symptoms of posterior and lateral columns of spinal cord and peripheral nerves. The serum vitamin B_(12) was lower than normal(180 pg/ml) in 5 patients. The hemoglobin was lower than normal(110 g/L) in 2 patients, and blood homocysteine was higher than normal(20 mmol/L) in 4 patients. Four patients underwent the nerve conduction velocity examination, which all showed peripheral neurogenic damage; 4 patients had abnormal signal in MRI of the brain and/or the spinal cord. Intrinsic factor antibody and antiparietal cell antibody were all positive in 3 patients, and 3 and 2 patients were positive intrinsic factor antibody or antiparietal cell antibody only respectively.Eight patients were all treated with intramuscular injection of vitamin B_(12)(1000 μg, once a day)for one month. The symptoms of these patients were all improved during follow-up. Conclusion Serum intrinsic factor and anti-parietal cell antibodies suggests possible SCD patients. Long-term intramuscular injection of vitamin B_(12) is recommended for SCD patients with positive intrinsic factor and/or anti-parietal cell antibody.
Objective To analyze the clinical features of subacute combined degeneration(SCD) of spinal cord with positive antibodies against intrinsic factor and/or parietal cell, and to evaluate the diagnostic value of these two antibodies for SCD. Methods The clinical features of eight patients with SCD with positive antibodies against intrinsic factor and/or parietal cells were retrospectively analyzed. The clinical data reviewed include demographic information, serum level of vitamin B_(12), hemoglobin and homocysteine, as well as neurophysiological scores and MRI imaging findings. Results Eight SCD patients enrolled in this study were subacute or chronic in disease onset, and deteriorated progressively.Only three patients presented with the combination symptoms of posterior and lateral columns of spinal cord and peripheral nerves. The serum vitamin B_(12) was lower than normal(180 pg/ml) in 5 patients. The hemoglobin was lower than normal(110 g/L) in 2 patients, and blood homocysteine was higher than normal(20 mmol/L) in 4 patients. Four patients underwent the nerve conduction velocity examination, which all showed peripheral neurogenic damage; 4 patients had abnormal signal in MRI of the brain and/or the spinal cord. Intrinsic factor antibody and antiparietal cell antibody were all positive in 3 patients, and 3 and 2 patients were positive intrinsic factor antibody or antiparietal cell antibody only respectively.Eight patients were all treated with intramuscular injection of vitamin B_(12)(1000 μg, once a day)for one month. The symptoms of these patients were all improved during follow-up. Conclusion Serum intrinsic factor and anti-parietal cell antibodies suggests possible SCD patients. Long-term intramuscular injection of vitamin B_(12) is recommended for SCD patients with positive intrinsic factor and/or anti-parietal cell antibody.
引文
[1]Gursoy AE,Kolukisa M,Babacan-Yildiz G,et al.Subacute Combined Degeneration of the Spinal Cord due to Different Etiologies and Improvement of MRI Findings[J].Case Rep Neurol Med,2013,2013:159649.
[2]Briani C,Dalla TC,Citton V,et al.Cobalamin deficiency:clinical picture and radiological findings[J].Nutrients,2013,5:4521-4539.
[3]Shah DR,Daver N,Borthakur G,et al.Pernicious anemia with spuriously normal vitamin B12 level might be misdiagnosed as myelodysplastic syndrome[J].Clin Lymphoma Myeloma Leuk,2014,14:e141-e143.
[4]郭军红,侯玉立,吴士文,等.对激素治疗敏感的脊髓亚急性联合变性一例[J].中国神经免疫学和神经病学杂志,2008,15:390-391.
[5]Loveridge N,Bitensky L,Chayen J,et al.Inhibition of parietal cell function by human gammaglobulin containing gastric parietal cell antibodies[J].Clin Exp Immunol,1980,41:264-270.
[6]Yi Y,Kang HJ,Shin HY,et al.Progressive Myelopathy Mimicking Subacute Combined Degeneration After Intrathecal Chemotherapy[J].J Child Neurol,2015,30:246-249.
[7]Rabhi S,Maaroufi M,Khibri H,et al.Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders:a case report and review of the literature[J].J Med Case Rep,2011,5:166.
[8]Sen A,Chandrasekhar K.Spinal MR imaging in Vitamin B12 deficiency:Case series;differential diagnosis of symmetrical posterior spinal cord lesions[J].Ann Indian Acad Neurol,2013,16:255-258.
[9]Renard D,Dutray A,Remy A,et al.Subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia[J].Neurol Sci,2009,30:75-76.
[2]Briani C,Dalla TC,Citton V,et al.Cobalamin deficiency:clinical picture and radiological findings[J].Nutrients,2013,5:4521-4539.
[3]Shah DR,Daver N,Borthakur G,et al.Pernicious anemia with spuriously normal vitamin B12 level might be misdiagnosed as myelodysplastic syndrome[J].Clin Lymphoma Myeloma Leuk,2014,14:e141-e143.
[4]郭军红,侯玉立,吴士文,等.对激素治疗敏感的脊髓亚急性联合变性一例[J].中国神经免疫学和神经病学杂志,2008,15:390-391.
[5]Loveridge N,Bitensky L,Chayen J,et al.Inhibition of parietal cell function by human gammaglobulin containing gastric parietal cell antibodies[J].Clin Exp Immunol,1980,41:264-270.
[6]Yi Y,Kang HJ,Shin HY,et al.Progressive Myelopathy Mimicking Subacute Combined Degeneration After Intrathecal Chemotherapy[J].J Child Neurol,2015,30:246-249.
[7]Rabhi S,Maaroufi M,Khibri H,et al.Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders:a case report and review of the literature[J].J Med Case Rep,2011,5:166.
[8]Sen A,Chandrasekhar K.Spinal MR imaging in Vitamin B12 deficiency:Case series;differential diagnosis of symmetrical posterior spinal cord lesions[J].Ann Indian Acad Neurol,2013,16:255-258.
[9]Renard D,Dutray A,Remy A,et al.Subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia[J].Neurol Sci,2009,30:75-76.