廿年多发性硬化住院患者临床特点及预后分析
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摘要
【研究目的】
首先，通过回顾性分析多发性硬化(multiple sclerosis，MS)患者的病史资料，总结出MS的临床特征，以提高疾病的早期诊断率。其次，结合患者的病史资料与EDSS评分，试图找出影响MS预后的因素，以指导临床。
【研究方法】
收集1987年2月—2007年4月间苏州大学附属第一医院、苏州大学附属第二医院及苏州市立医院本部(原苏州市第二人民医院)共120例多发性硬化住院患者的病史资料，分析其年龄、性别、发病诱因、首发症状、主要症状和体征、影像学表现、脑脊液及神经电生理检查的特点。根据每位患者的神经功能缺损情况，运用EDSS评分量表，对其首次入院、首次出院、末次入院、末次出院时的神经功能状态进行评分。对不同年龄、性别、首发症状、首发与复发间隔时间、各临床亚型的EDSS评分结果进行比较。定量资料用方差分析进行统计学处理。
【研究结果】
1、以眩晕、呕吐为首发症状的多发性硬化患者出现率高达10.0％。
2、120例MS患者中25％的患者出现发作性症状，以发作性感觉异常(10.8％)、痛性强直发作(9.2％)、Lhermitte症(10.0％)、癫痫(8.1％)占多数。
3、在以感觉障碍、视力障碍为首发症状的患者中，复发缓解型分别占75％和69.2％，显著高于继发进展型和原发进展型(vs.12.5％、7.7％和4.2％、3.8％)；继发进展型的患者中58.8％以运动障碍为首发症状。
4、MS患者VEP、SEP检查阳性率分别为66.0％和64.3％，较BAEP阳性率(54.7％)高。
5、以感觉障碍、视觉障碍、脑干小脑症状为首发表现的患者，治疗后EDSS评分分别为：3.1±2.1、2.7±2.1、2.4±2.2，显著低于以运动症状为首发的患者：4.5±2.4(p＜0.05)。
6、发病年龄小于40岁的女性患者及大于40岁的男性患者治疗后的EDSS评分分别为3.0±2.6和2.7±1.9，显著低于40岁以上发病的女性患者(4.6±2.8，p＜0.05)。
7、首次发病后2年内复发的MS患者治疗后EDSS评分为3.5±2.6，而2年后复发的MS患者治疗后EDSS评分为2.4±2.0(p＜0.05)。
8、复发缓解型、继发进展型、原发进展型患者首次入院时的EDSS评分分别为：4.6±1.9、5.4±1.6和4.4±0.7，三者间无显著性差异(P＞0.05)。治疗后继发进展型、原发进展型患者EDSS评分分别为7.0±1.7、7.0±1.6，显著高于复发缓解型的2.3±1.8(p＜0.05)。
9、视神经脊髓炎(neuromyelitis optica，NMO)与经典型MS在初次发病时的EDSS评分分别为3.6±1.3和3.7±1.61，两者间无显著性差异(P＞0.05)。治疗后NMO的EDSS评分为4.1±2.8显著高于MS的2.7±2.7(p＜0.05)。
【结论】
1、本组多发性硬化住院患者资料显示以眩晕、呕吐为首发症状的出现率较高。
2、25％的患者出现发作性症状，可作为MS的相对特征性表现。
3、对临床上高度怀疑MS的患者早期行诱发电位检查，尤其是VEP和SEP检查对提高确诊率很有意义。
4、性别、发病年龄、首发症状、首次发病与复发的间隔时间，均能影响MS的预后，临床上可以结合以上因素来对MS患者进行预防、早期预后判断和指导治疗，以减轻神经功能缺损严重程度。
【Objective】
Firstly, through retrospectively analyzing medical records of patients with multiplesclerosis (MS), we summarized the clinical manifestations of MS for early diagnosis.Secondly, combining the patients' medical records and Expanded Disability Status Scale(EDSS) score, we try to determine the prognostic factors of MS in order to direct futureclinical medication.
【Methods】
We studied the features of age, sex, inducing factor, symptoms at onset, presentsymptoms and signs, imaging findings, cerebrospinal fluid and neuro- electrophysiologicexaminations of 120 patients with MS, who were in the First Affiliated Hospital ofSoochow University, Second Affiliated Hospital of Soochow University and the SecondPeople's Hospital of Suzhou between 1987 and 2007. According to the neurologicimpairment condition of each person at initial hospitalization, initial discharge, finalhospitalization and final discharge, their EDSS scores were achieved and then, the EDSSscores were compared among different groups dividing in age, sex, symptoms at onset,interval between the first and second attack or individual clinical subtype, respectively.Quantitative data was analyzed by ANOVA.
【Results】
1. The frequency of vertigo and vomit at onset in our MS group is as high as 10.0%.
2. 25% in 120 patients with MS appear paroxysmal symptoms, which predominantlypresent paroxysmal paresthesias (10.8%), tonic spasms(9.2%), Lhermitte (10.0%)and epilepsy (8.1%).
3. In patients who presented sensory and optic symptoms at onset, relapsing-remitting MS(RRMS) accounts for 75% and 69.2% respectively, which are significantly higherthan secondary progressive MS (SPMS, 12.5% and 7.7%) and primary progressiveMS(PPMS,4.2% and 3.8%). 58.5% patients in SPMS present motor symptoms atonset.
4. The positive ratio of VEP and SEP for MS are 66.0% and 64.3% respectively, which isremarkable higher than 54.7% in BAEP.
5. In patients who presented sensory, optic, brainstem and cerebellar symptoms at onset,the EDSS score after treatment are: 3.1±2.1, 2.7±2.1 and 2.4±2.2, which aresignificantly lower than 4.5±2.4 (p＜0.05) in patients with motor symptoms at onset.
6. After treatment, the EDSS score in female of age＜40 and male of age≥40 are 3.0±2.6 and 2.7±1.9, which significantly lower than 4.6±2.8 (p＜0.05) in women ofage≥40.
7. After treatment, the EDSS score in patients with interval between the first and secondattack less than 2 years is 3.5±2.6, which is significantly higher than 2.4±2.0 in patientswith interval more than 2 years.
8. The EDSS score in RRMS, SPMS, PPMS at initial hospitalization are: 4.6±1.9, 5.4±1.6 and 4.4±0.7, and there are no differences between them (p＞0.05). Aftertreatment, the score in SPMS and PPMS are: 7.0±1.7 and 7.0±1.6, which issignificantly higher than 2.3±1.8 (p＜0.05) in RRMS.
9. The EDSS score of neuromyelitis optica (NMO) and classical MS are:3.6±1.3 and3.7±1.61 and there are no differences between them (p＞0.05). But after treatment, thescore of NMO is 4.1±2.8, which significantly higher than that of classical MS(2.7±2.7, p＜0.05).
【Conclusions】
1. The incidence of vertigo and vomit at onset in patients with MS is high.
2. Paroxysmal symptoms can be seen in 25% MS patients, which can be considered ascharacteristic manifestations for MS.
3. The evoked potential examinations, especially VEP and SEP, are helpful to patientswith clinical probable MS and may enhance the rate of diagnosis.
4. Sex, age at onset, symptoms at onset, interval between the first and second attack allcan affect the prognosis of MS. Clinically, these factors can be used to judge the prognosis early and guide precaution and treatment decisions to alleviate the physicaldisability.
首先，通过回顾性分析多发性硬化(multiple sclerosis，MS)患者的病史资料，总结出MS的临床特征，以提高疾病的早期诊断率。其次，结合患者的病史资料与EDSS评分，试图找出影响MS预后的因素，以指导临床。
【研究方法】
收集1987年2月—2007年4月间苏州大学附属第一医院、苏州大学附属第二医院及苏州市立医院本部(原苏州市第二人民医院)共120例多发性硬化住院患者的病史资料，分析其年龄、性别、发病诱因、首发症状、主要症状和体征、影像学表现、脑脊液及神经电生理检查的特点。根据每位患者的神经功能缺损情况，运用EDSS评分量表，对其首次入院、首次出院、末次入院、末次出院时的神经功能状态进行评分。对不同年龄、性别、首发症状、首发与复发间隔时间、各临床亚型的EDSS评分结果进行比较。定量资料用方差分析进行统计学处理。
【研究结果】
1、以眩晕、呕吐为首发症状的多发性硬化患者出现率高达10.0％。
2、120例MS患者中25％的患者出现发作性症状，以发作性感觉异常(10.8％)、痛性强直发作(9.2％)、Lhermitte症(10.0％)、癫痫(8.1％)占多数。
3、在以感觉障碍、视力障碍为首发症状的患者中，复发缓解型分别占75％和69.2％，显著高于继发进展型和原发进展型(vs.12.5％、7.7％和4.2％、3.8％)；继发进展型的患者中58.8％以运动障碍为首发症状。
4、MS患者VEP、SEP检查阳性率分别为66.0％和64.3％，较BAEP阳性率(54.7％)高。
5、以感觉障碍、视觉障碍、脑干小脑症状为首发表现的患者，治疗后EDSS评分分别为：3.1±2.1、2.7±2.1、2.4±2.2，显著低于以运动症状为首发的患者：4.5±2.4(p＜0.05)。
6、发病年龄小于40岁的女性患者及大于40岁的男性患者治疗后的EDSS评分分别为3.0±2.6和2.7±1.9，显著低于40岁以上发病的女性患者(4.6±2.8，p＜0.05)。
7、首次发病后2年内复发的MS患者治疗后EDSS评分为3.5±2.6，而2年后复发的MS患者治疗后EDSS评分为2.4±2.0(p＜0.05)。
8、复发缓解型、继发进展型、原发进展型患者首次入院时的EDSS评分分别为：4.6±1.9、5.4±1.6和4.4±0.7，三者间无显著性差异(P＞0.05)。治疗后继发进展型、原发进展型患者EDSS评分分别为7.0±1.7、7.0±1.6，显著高于复发缓解型的2.3±1.8(p＜0.05)。
9、视神经脊髓炎(neuromyelitis optica，NMO)与经典型MS在初次发病时的EDSS评分分别为3.6±1.3和3.7±1.61，两者间无显著性差异(P＞0.05)。治疗后NMO的EDSS评分为4.1±2.8显著高于MS的2.7±2.7(p＜0.05)。
【结论】
1、本组多发性硬化住院患者资料显示以眩晕、呕吐为首发症状的出现率较高。
2、25％的患者出现发作性症状，可作为MS的相对特征性表现。
3、对临床上高度怀疑MS的患者早期行诱发电位检查，尤其是VEP和SEP检查对提高确诊率很有意义。
4、性别、发病年龄、首发症状、首次发病与复发的间隔时间，均能影响MS的预后，临床上可以结合以上因素来对MS患者进行预防、早期预后判断和指导治疗，以减轻神经功能缺损严重程度。
【Objective】
Firstly, through retrospectively analyzing medical records of patients with multiplesclerosis (MS), we summarized the clinical manifestations of MS for early diagnosis.Secondly, combining the patients' medical records and Expanded Disability Status Scale(EDSS) score, we try to determine the prognostic factors of MS in order to direct futureclinical medication.
【Methods】
We studied the features of age, sex, inducing factor, symptoms at onset, presentsymptoms and signs, imaging findings, cerebrospinal fluid and neuro- electrophysiologicexaminations of 120 patients with MS, who were in the First Affiliated Hospital ofSoochow University, Second Affiliated Hospital of Soochow University and the SecondPeople's Hospital of Suzhou between 1987 and 2007. According to the neurologicimpairment condition of each person at initial hospitalization, initial discharge, finalhospitalization and final discharge, their EDSS scores were achieved and then, the EDSSscores were compared among different groups dividing in age, sex, symptoms at onset,interval between the first and second attack or individual clinical subtype, respectively.Quantitative data was analyzed by ANOVA.
【Results】
1. The frequency of vertigo and vomit at onset in our MS group is as high as 10.0%.
2. 25% in 120 patients with MS appear paroxysmal symptoms, which predominantlypresent paroxysmal paresthesias (10.8%), tonic spasms(9.2%), Lhermitte (10.0%)and epilepsy (8.1%).
3. In patients who presented sensory and optic symptoms at onset, relapsing-remitting MS(RRMS) accounts for 75% and 69.2% respectively, which are significantly higherthan secondary progressive MS (SPMS, 12.5% and 7.7%) and primary progressiveMS(PPMS,4.2% and 3.8%). 58.5% patients in SPMS present motor symptoms atonset.
4. The positive ratio of VEP and SEP for MS are 66.0% and 64.3% respectively, which isremarkable higher than 54.7% in BAEP.
5. In patients who presented sensory, optic, brainstem and cerebellar symptoms at onset,the EDSS score after treatment are: 3.1±2.1, 2.7±2.1 and 2.4±2.2, which aresignificantly lower than 4.5±2.4 (p＜0.05) in patients with motor symptoms at onset.
6. After treatment, the EDSS score in female of age＜40 and male of age≥40 are 3.0±2.6 and 2.7±1.9, which significantly lower than 4.6±2.8 (p＜0.05) in women ofage≥40.
7. After treatment, the EDSS score in patients with interval between the first and secondattack less than 2 years is 3.5±2.6, which is significantly higher than 2.4±2.0 in patientswith interval more than 2 years.
8. The EDSS score in RRMS, SPMS, PPMS at initial hospitalization are: 4.6±1.9, 5.4±1.6 and 4.4±0.7, and there are no differences between them (p＞0.05). Aftertreatment, the score in SPMS and PPMS are: 7.0±1.7 and 7.0±1.6, which issignificantly higher than 2.3±1.8 (p＜0.05) in RRMS.
9. The EDSS score of neuromyelitis optica (NMO) and classical MS are:3.6±1.3 and3.7±1.61 and there are no differences between them (p＞0.05). But after treatment, thescore of NMO is 4.1±2.8, which significantly higher than that of classical MS(2.7±2.7, p＜0.05).
【Conclusions】
1. The incidence of vertigo and vomit at onset in patients with MS is high.
2. Paroxysmal symptoms can be seen in 25% MS patients, which can be considered ascharacteristic manifestations for MS.
3. The evoked potential examinations, especially VEP and SEP, are helpful to patientswith clinical probable MS and may enhance the rate of diagnosis.
4. Sex, age at onset, symptoms at onset, interval between the first and second attack allcan affect the prognosis of MS. Clinically, these factors can be used to judge the prognosis early and guide precaution and treatment decisions to alleviate the physicaldisability.
引文
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