结核分枝杆菌感染与难治性不完全性脊髓炎的初步研究  

A pilot study of mycobacteria infection in incomplete transverse myelitis refractory to steroids

作　　者：丰岩清[1] 国宁[2] 黄帆[1] 陈曦[1] 孙巧松[1] 刘俊秀[1] 

机构地区：[1]中山大学附属第一医院神经科,广州510080 [2]中山大学附属第一医院神经外科,广州510080

出　　处：《中华临床医师杂志（电子版）》2010年第1期22-25,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：教育部高等学校博士学科点专项科研基金新教师课题(200805581139);中山大学医科青年教师科研启动基金(2008011);广东省医学科研课题(B2009056)

摘　　要：目的本研究旨在应用抗结核分枝杆菌治疗(ATT)的方法,探索激素治疗无效的脊髓炎的可治性以及探讨ITM与分枝杆菌感染的关系。方法本研究是一项前瞻性研究,2003年1月至2009年6月对67例难治性脊髓炎患者进行了抗结核分枝杆菌诊断性治疗,排除已知的病因,观察至少1年。患者接受抗结核诊断性治疗,治疗前后采用美国脊髓损伤协会(ASIA)标准(2000年修订)评价脊髓神经功能,Barthel指数(BI)评分评价脊髓损伤患者日常活动能力;Hauser步行指数(AI)评价患者的行走能力。脊髓磁共振检查对治疗前后的异常信号进行跟踪随访。结果67例患者中16例因治疗无效和药物不良反应退出本研究。完成临床观察51例,49例好转,ASIA运动、感觉功能评分、BI和AI评分较治疗前均有较明显改善(P<0.01)。脊髓磁共振异常信号逐步减少。结论本研究显示抗结核治疗对大部分难治性不完全性脊髓炎有效,显示分枝杆菌感染可能是一些难治性脊髓炎重要的和被忽视的病因。Objective Incomplete transverse myelitis （ITM） of unknown origin is associated with high rates of morbidity and mortality, and treatment options for these patients are few. This pilot study was undertaken to determine whether antituberculous treatment （ATT） might help in patients with ITM whose condition continued to worsen despite receiving IV methylprednisolone treatment. Methods This is a prospective, open-label study. A group of 67 patients with steroid-refractory ITM were included from Jan 2003 to Jun 2009, and known causes of myelopathy were excluded. They underwent trial chemotherapy of ATT. All patients were followed up for at least 1 year after treatment. Efficacy was assessed by the ASIA scoring system,Barthel Index （BI） and Hauser Ambulation Index （AI） at baseline and at 12 months,and magnetic resonance imaging （MRI） changes were also assessed. Results Of 67 patients enrolled, 16 withdrew. 51 patients completed the entire course of treatment; and were able to be assessed. At 12 months,49 patients experienced benefits. ASIA rating, BI significantly increased, Hauser AI improved validity, concomitantly with markedly decreased abnormal signals in spinal cord on MRI over time. Conclusions The results from this perspective study provide beneficial clinical and MRI data on the efficacy of ATT in ITM patients, and suggests mvcobacteria mav be an important and being neglected infection of myelitis.

关 键 词：脊髓炎 分枝杆菌感染 抗结核药 

分 类 号：R744.3[医药卫生—神经病学与精神病学]