脊髓亚急性联合变性的临床特征分析  

Clinical features and marker levels of subacute combined degeneration of spinal cord

作　　者：臧卫周[1] 杨红 张杰文[1] YAN Weizhou;YANG Hong;ZHANG Jiewen(Department of Neurology,Henan Provincial People's Hospital,Zhengzhou 453003,China;First People's Hospital of Shangqiu,Shangqiu 476000,China)

机构地区：[1]河南省人民医院神经内科,河南郑州453003 [2]商丘市第一人民医院,河南商丘476000

出　　处：《中国实用神经疾病杂志》2020年第1期40-44,共5页Chinese Journal of Practical Nervous Diseases

基　　金：2015年河南省科技攻关计划项目(编号:152102310140.0)。

摘　　要：目的总结脊髓亚急性联合变性患者的临床表现及磁共振成像、肌电图的特点,并探索血中有关标志物水平与神经损害程度的相关性。方法回顾性分析2016-12—2018-05于河南省人民医院临床确诊的50例脊髓亚急性联合变性患者的临床特点,用Spearman秩相关分析血标志物水平与神经损害程度的相关性。结果首次发病年龄16~86(58.92±16.52)岁,其中60岁以上首次发病27例(54%),男34例(68%);50例患者中累及周围神经者31例(62%),后索者46例(92%),侧索者27例(54%),大脑白质与视神经损害10例(20%);36例(72%)患者行神经传导速度检查,25例(69%)有异常改变;50例患者全部行常规MRI检查,19例(38%)行常规加增强MRI检查,其中25例(50%)患者发现病灶;血清平均血红蛋白浓度、血清VitB12水平与神经功能损伤程度无显著相关性(P>0.05),血清平均红细胞体积、叶酸、同型半胱氨酸水平与神经功能损伤程度呈正相关(r>0),红细胞计数、血红蛋白、平均血红蛋白量、总蛋白、白蛋白与神经功能损伤程度呈负相关性(r<0)。结论SCD患者临床上以脊髓后索损害较为常见,辅助检查中神经电生理检查检出率高于MRI;且对于院前补充过VitB12或者功能性VitB12缺乏的SCD患者,血清中的其他标志物可以作为间接参考指标。Objective To summarize the clinical manifestation,magnetic resonance imaging(MRI)and electromyography(EMG)of patients with subacute combined degeneration of the spinal cord,and to explore the correlation between the level of related markers in blood and the degree of nerve damage.Methods The clinical features of 50 patients with subacute combined degeneration of spinal cord diagnosed in our hospital from December 2016 to May 2018 were retrospectively analyzed.The measurement data were expressed as x±s,and the enumeration data were expressed as number of cases and percentage(%);The correlation between the level of blood markers and the degree of nerve damage was analyzed using Spearman's rank correlation.Result The age of onset was 16-86 years,with an average of 58.92±16.52 years,of which 27 patients(54%)were over 60 years old and 34(68%)were male for the first time;31(62%)of 50 patients had peripheral nerve involvement,46(92%)had posterior cord,27(54%)had lateral cord,10(20%)had cerebral white matter and optic nerve damage;36(72%)patients underwent nerve conduction velocity examination and 25(69%)had abnormal changes;all 50 patients underwent conventional MRI and 19(38%)underwent conventional plus enhanced MRI,of which 25(50%)patients were found to have lesions;there was no significant correlation between serum mean hemoglobin concentration,serum VitB12 level and degree of neurological impairment(P>0.05),and there was a positive correlation(r>0)between serum mean corpuscular volume,homocysteine level,degree of homocysteine and degree of neurological impairment.Conclusion Posterior cord injury is more common in SCD patients,and the detection rate of neurophysiological examination in auxiliary examination is higher than that in MRI.In addition,other markers in serum can be used as indirect reference indicators for SCD patients with VitB12 supplementation or functional VitB12 deficiency before hospitalization.

关 键 词：脊髓亚急性联合变性 高同型半胱氨酸血症 维生素B12 肌电图 磁共振特征 

分 类 号：R744[医药卫生—神经病学与精神病学]