多发性硬化和视神经脊髓炎疾病谱患者腹壁反射研究  

Superficial abdominal reflex in multiple sclerosis and neuromyelitis optica spectrum disorders

作　　者：尹俊杰[1] 毛志锋[1] 邱伟[1] 伍爱民[1] 陆正齐[1] 胡学强[1] 

机构地区：[1]中山大学附属第三医院神经内科,510630

出　　处：《中国神经免疫学和神经病学杂志》2015年第5期315-319,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的 探讨腹壁反射在鉴别多发性硬化（MS）和视神经脊髓炎疾病谱（NMOSD）中的临床意义。方法收集作者医院确诊的MS（30例）和NMOSD（55例）患者的一般临床资料,并对其进行脊髓MRI、腹壁反射及巴宾斯基征检查,分析各组患者腹壁反射、巴宾斯基征以及脊髓MRI影像学特点。结果 MS患者腹壁反射正常者15例（50.0%）,腹壁反射消失者7例（23.3%）,巴宾斯基征阴性者12例（40.0%）,NMOSD患者腹壁反射正常者5例（9.1%）,腹壁反射消失者44例（80.0%）,巴宾斯基征阴性者7例（12.7%）,两组间比较差异均有统计学意义（均P〈0.01）。视神经脊髓型多发性硬化（OSMS）患者腹壁反射减弱5例（41.7%）,NMOSD患者6例（10.9%）,两组间比较差异有统计学意义（P〈0.05）。腹壁反射正常预测MS的特异度为90.91%（95%CI：79.29～96.60）,腹壁反射减弱预测OSMS的特异度为87.67%（95%CI：77.39～93.86）,腹壁反射消失预测NMOSD的特异度为76.67%（95%CI：57.30～89.37）,巴宾斯基征阴性预测MS的特异度为87.27%（95%CI：74.91～94.31）。脊髓MRI分析结果提示脊髓横断面损伤越严重,越容易出现腹壁反射异常。结论 腹壁反射消失提示NMOSD可能性大,腹壁反射正常提示MS可能性大,腹壁反射减弱为OSMS的可能性较NMOSD大。Objective To investigate the clinical significance of the superficial abdominal reflex （SAR） in differentiating between multiple sclerosis （MS） and neuromyelitis optica spectrum disorders （NMOSD）. Methods MS （n=30） and NMOSD （n=55） patients in the authors＇ hospital were enrolled. SAR and Babinski sign were examined and evaluated. MRI data and the signs in these diseases were analyzed. Results Abdominal reflexes of MS patients were normal in 15 cases （50.0%）, and disappeared in 7 cases （23.3%）; Babinski sign was negative in 12 patients （40.0%）. In NMOSD patients, abdominal reflexes were normal in 5 patients （9.1%）, and disappeared in 44 patients （80.0%）; Babinski sign was negative in 7 cases （12.7%）, the differences between the two groups were statistically significant （P〈0.01, respectively）. Abdominal reflexes of optico spinal multiple sclerosis （OSMS） patients were weakened in 5 patients （41.7%）, while NMOSD patients accounted for 6 （10.9 %）, the difference between the two groups was statistically significant （P〈0.05）. The specificity of normal SAR to predict MS was 90.91% （95%CI： 79.29-96.60）. The specificity of weak SAR to predict OSMS was 87.67% （95% CI： 77.39-93.86）. The specificity of weak SAR to predict NMOSD was 76.67% （95%CI： 57.30-89.37）. The specificity of negative Babinski sign to predict MS was 87.27% （95% CI： 74.91-94.31）. MRI analysis indicated that the NMOSD more often involved spinal cord while the MS more often involved cerebral hemisphere, midbrain and pons. The spinal cord injury was more severe in the transverse section, the more likely to appear the SAR abnormality. Conclusions SAR could help us differentiate NMOSD from MS. Absence of SAR may indicate the NMOSD, and normal SAR shows MS probably. SAR weakness may indicate OSMS rather than NMOSD. SAR combining Babinski sign could help improve the differential diagnosis.

关 键 词：多发性硬化 视神经脊髓炎疾病谱 腹壁反射 巴宾斯基征 诊断 鉴别 

分 类 号：R744.5[医药卫生—神经病学与精神病学]