笑气中毒导致脊髓病变的临床分析  

The clinical characteristics of myelopathy following recreational nitrous oxide use

作　　者：陶东霞[1] 姜季委 李美欣 张壑然 商秀丽[1] TAO Dongxia;JIANG Jiwei;LI Meixin(Department of Neurology,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院神经内科,辽宁沈阳110001

出　　处：《中风与神经疾病杂志》2019年第4期335-339,共5页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金(No.81100243;81502181);辽宁省重点研发计划指导计划(No.2017225027);沈阳市科技计划项目(No.17-230-9-17)

摘　　要：目的 探讨笑气中毒致脊髓病变的临床表现、血清学以及影像学的特点,以提高临床对笑气中毒致脊髓亚急性联合变性的认识。方法 回顾性分析2017年10月-2018年12月中国医科大学附属第一医院神经内科收治的12例确诊笑气中毒致脊髓病变患者的临床资料,总结其临床症状严重程度与血红蛋白、血清维生素B12和同型半胱氨酸水平以及影像学表现的特点,并分析吸食笑气时间(以6 m为界)与磁共振成像的关系。结果 12例患者平均发病年龄为(23. 75±4. 52)岁,均有不同程度的神经系统受损表现,血红蛋白降低者3例(25. 00%),血清维生素B12降低者7例(58. 33%),血清同型半胱氨酸升高者12例(100%);磁共振成像示脊髓侧索、后索T2加权高信号7例(58. 33%);吸食笑气时间≥6 m者6例(50. 00%),<6 m者6例(50. 00%)。结论 笑气中毒致脊髓亚急性联合变性多见于健康年轻人,血清同型半胱氨酸升高较血红蛋白和血清维生素B12水平下降对该病诊断更有意义;磁共振成像与否可能与吸食笑气时间长短有关。Objective To explore the diverse presentations,ancillary tests and neuroimaging in patients with nitrous oxide-induced myelopathy.Methods Twelve patients with N 2O-induced SCD were included in this study.The severity of neurological impairment with laboratory data including serum vitamin B12 levels,hemoglobin,and homocysterine were analyzed,and images of spinal cord on magnetic resonance imaging(MRI)were evaluated.Results The average age of disease onset was(23.75±4.52).For most of the patients,sensory symptoms,often times as initial symptoms,occurred earlier than motor symptoms.There were only three patients(25%)with decreased hemoglobin.Decreased serum vitamin B12 levels was detected in seven patients(58.33%).Elevated serum levels of homocysterine were found in all of our patients(100%).Spinal cord lesions on MRI were observed in seven patients(58.33%).A half of the patients spent time abusing N 2O over six months,and the other was within six months.Conclusion The nitrous oxide-induced myelopathy always occurred in young.The elevated serum homocysterine is more effective than the decreased serum hemoglobin and vitamin B12.The occurrence rate of MRI may be associated with the time of abused N 2O.

关 键 词：氧化亚氮 亚急性联合变性 临床症状 磁共振成像 维生素B12 同型半胱氨酸 

分 类 号：R744[医药卫生—神经病学与精神病学]