26例急性脱髓鞘脑病患者临床观察  

The clinical analysis of 26 patients with acute demyelinating encephalopathy

作　　者：陈秋红 袁菲菲 杜律律 

机构地区：[1]上海市嘉定区中心医院神经内科,上海201800

出　　处：《脑与神经疾病杂志》2013年第1期4-6,共3页Journal of Brain and Nervous Diseases

摘　　要：目的探讨急性脱髓鞘脑病的临床表现和诊治特点。方法对26例急性脱髓鞘脑病患者一般临床资料、脑脊液、脑电图及影像学检查结果进行分析,给予标准剂量激素(地塞米松10 mg.d-1),或大剂量甲基泼尼松龙静脉冲击治疗(20～30 mg.kg-1.d-1),联合丙种球蛋白(400 mg.kg-1.d-1)和神经营养药物治疗并观察疗效。结果 14例患者脑脊液异常,所有患者脑电图均异常,MRI检查脱髓鞘病灶呈T1低信号或等信号、T2高信号改变、形状多不规则。总有效率88.5%,治疗结果好转23例,无效3例。结论急性脱髓鞘脑病临床表现多样,影像学有助于明确诊断,EEG有助于评价疗效,激素和丙种球蛋白联用疗效较好。Objective To evaluate the clinical features and diagnostic characteristics of patients with acute demyelinating eneephalopathy （ADE）. Methods Totally 26 ADE patients were enrolled in the study. Hormone therapy, standard - dose dexamethasone （ 10 mg · d^-1 ） or high - dose methylprednisolone injection （ 20 30 mg ·kg^-1·d^-1） , combined with immunoglobulin （400 mg ·kg^-1·d^-1） and neurotrophic drugs were given to these patients. Clinical materials, cerebrospinal fluid （CSF） , electroencephalogram （EEG） , radiological outcomes were analyzed and the effectiveness of treatment were evaluated. Results CSF abnormalities were found in fourteen patients and abnormal waves in electroencephalogram were found in all 26 patients. Magnetic resonance imaging （MRI） showed low or equal intensity signal on T1 - weighted images and high intensity signal on T2 - weighted images, with irregular shape. The effective rate was 88.5% , 23 patients improved while 3 patient showed no effects al all. Conclusion The clinical features of ADE patients are complex. Imaging examination could be helpful in diagnosis of ADE and EEG results could be helpful to assess the effectiveness of treatment. Hormone therapy combined with＇ immunoglobulin has a satisfactory effect.

关 键 词：急性脱髓鞘脑病 自身免疫性 临床分析 

分 类 号：R745.1[医药卫生—神经病学与精神病学]