8例脊髓亚急性联合变性临床分析  

Clinical analysis of 8 cases of subacute combined degeneration of spinal cord and literature review

作　　者：杨芬[1] 张英谦[1] 吕强[1] 张卫清[1] 宋琛[1] 赵炫柱 胡文娟[1] 石进[1] 

机构地区：[1]空军总医院神经内科,北京100142

出　　处：《中国实用神经疾病杂志》2015年第7期13-14,共2页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨脊髓亚急性联合变性的临床特点。方法回顾性分析8例脊髓亚急性联合变性患者的临床资料,并进行文献复习。结果本组8例患者,男4例,女4例,均以双下肢无力或麻木为首发症状,长期素食者4例,萎缩性胃炎者3例。所有患者均在后索及周围神经受累体征,同时累及侧索4例,累及脑2例。巨细胞贫血5例,维生素B12水平降低4例,叶酸水平全部正常,5例患者行血同型半胱氨酸检查,均提示升高,肌电图主要表现为感觉神经损害及体感诱发电位异常。脊髓磁共振仅1例脊髓内有异常信号,经应用维生素B12治疗后,全部患者病情有改善。结论脊髓亚急性联合变性临床表现复杂,维生素B12水平可正常,同型半胱氨酸有可能是其诊断指标之一。综合分析患者的症状体征及实验室检查,尽早给予维生素B12治疗。Objective To explore the clinical characteristic of subacute combined degeneration of spinal cord （SCD） .Meth‐ods We retrospectively analyzed 8 patients with SCD and reviewed the related literature.Results This group of patients in‐cluded 4 males and 4 females.Clinical presentations at onset showed lower limbs weakness or numbness.Four patients were long‐term vegeterians. Three patients were chronic atrophic gastritis. All patients showed posterior columns and peripheral nerve signs.Lateral column involvement was noted in four patients.Brain involvement was noted in two patients.Anemia was found in five patients. The serum VitB12 level was low in four patients. The serum folate level was normal in all pa‐tients.Homocysteine level was elevate in five patients who was conducted this test.Electromyography showed sensory nerve damage and abnormal somatosensory evoked potential.Spinal MRI showed intramedullary abnormal signal in one patient.After the treatment of Vitamin B12 ,all patients received clinical improvement.Conclusion The clinical presentation of SCD is com‐plex. The serum VitB12 level is normal in so me patients. Homoc ysteine level may be a marker of SCD. Analysis of clinical presentation and laboratory examination plays an important role in the diagnosis of SCD. Treatment with VitB12 as early as pos‐sible is necessary.

关 键 词：脊髓亚急性联合变性 维生素B12 同型半胱氨酸 

分 类 号：R744.6[医药卫生—神经病学与精神病学]