放射学孤立综合征与经典多发性硬化的临床对比分析  

Comparison of clinical features between radiological isolated syndrome and classical multiple sclerosis

作　　者：黎普刚[1] 郑双双[2] 陈伟康[1] 汤亚男[1] 卢丽萍[1] 董瑞国[3] 马海朋[3] 

机构地区：[1]浙江省丽水市人民医院神经内科,323000 [2]浙江省丽水市人民医院康复医学科,323000 [3]徐州医学院附属医院神经内科

出　　处：《中国医师进修杂志》2016年第4期306-310,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 比较放射学孤立综合征（RIS）与经典多发性硬化（CMS）的临床特点,提高对RIS的认识.方法 对35例RIS和32例CMS患者的一般资料、临床表现、脑脊液、神经电生理及磁共振成像（MRI）检查结果进行回顾性分析.结果 RIS和CMS患者性别构成、年龄比较差异无统计学意义（P〉0.05）.RIS患者就诊症状以头痛（45.7%,16/35）、头晕（40.0%,14/35）、记忆力减退（20.0%,7/35）及精神症状（11.4%,4/35）为主,CMS患者以肢体无力（75.0%,24/32）、感觉异常（68.8%,22/32）和眼部症状（34.4%,11/32）为主.CMS患者肢体无力、感觉异常、眼部症状发生率明显高于RIS患者[75.0%（24/32）比0、68.8%（22/32）比0、34.4%（11/32）比0],差异有统计学意义（P〈0.01）.18例RIS患者和21例CMS患者进行了脑脊液检查,两者白细胞比较差异无统计学意义（P〉0.05）;RIS患者蛋白、IgG指数〉0.7发生率明显低于CMS患者[0.175（0.03～0.69）g/L比0.440（0.04～1.09）g/L、3/18比47.6%（10/21）],差异有统计学意义（P〈0.05）.15例RIS患者和22例CMS患者进行了神经电生理检查,RIS患者视觉诱发电位（VEP）、脑干听觉诱发电位（BAEP）异常率明显低于CMS患者[4/15比63.6%（14/22）、3/15比54.5%（12/22）],差异有统计学意义（P〈0.05）,两者体感诱发电位（SEP）异常率比较差异无统计学意义（P〉0.05）.在MRI上,RIS与CMS患者的病灶均主要分布于侧脑室旁、半卵圆中心及近皮质的脑白质,部分累及胼胝体和皮质;RIS患者的病灶位于脑干、小脑发生率明显低于CMS患者[5.7%（2/35）比34.4%（11/32）、2.9%（1/35）比25.0%（8/32）],差异有统计学意义（P〈0.01或〈0.05）.与CMS相比,RIS病灶以斑片状和斑点状小病灶为主,差异有统计学意义（P〈0.01或〈0.05）;RIS患者MRI增强示病灶强化和脊髓受累发生率明显低于CMS患者[2/17比45.0%（9/20）、1/14比43.5%（10/23）],差异有统计学意义（P〈{Abstract}： Objective To compare the clinical features between radiological isolated syndrome （RIS） and classical multiple sclerosis （CMS）, in order to improve the understanding of the RIS. Methods All 35 patients with RIS and 32 patients with CMS were selected. The epidemiological and clinical findings, cerebrospinal fluid, neural electrophysiological examination and magnetic resonance imaging （MRI） data were analyzed. Results There were no statistical differences in sex ratio and onset age between RIS patients and CMS patients （P〉0.05）. The main symptoms of in patients with RIS were headache （45.7%, 16/35）, dizziness （40.0%, 14/35）, hypomnesis （20.0%, 7/35） and psychiatric disorders （11.4%, 4/35）. But the main symptoms of in patients with CMS were limb weakness （75.0%, 24/32）, sensory abnormalities （68.8%, 22/32） and ocular symptoms （34.4%,11/32）. The incidences of limb weakness, sensory abnormalities and ocular symptoms in patients with CMS were significantly higher than those in patients with RIS：75.0%（24/32） vs. 0, 68.8%（22/32） vs. 0 and 34.4%（11/32） vs. 0, and there were statistical differences （P〈0.01）. The 18 patients with RIS and 21 patients with CMS underwent the examination of cerebrospinal fluid, and there was no significant difference in leukocyte between patients with RIS and patients with CMS （P〉0.05）. The cerebrospinal fluid protein and the incidences of IgG index〉0.7 in patients with RIS were significantly lower than those in patients with CMS：0.175 （0.03-0.69） g/L vs. 0.440 （0.04-1.09） g/L and 3/18 vs. 47.6%（10/21）, and there were statistical differences （P〈0.05）. The 15 patients with RIS and 22 patients with CMS underwent the examination of neural electrophysiological, and the abnormality rates of visual evoked potential （VEP） and brain stem auditory evoked potential （BAEP） in patients with RIS were significantly lower than those in patients with CMS：4/15 vs. 63.6%（14/22） and 3/15 vs. 5

关 键 词：脱髓鞘疾病 多发性硬化 回顾性研究 放射学孤立综合征 

分 类 号：R744.51[医药卫生—神经病学与精神病学]