内因子抗体和(或)抗胃壁细胞抗体阳性的脊髓亚急性联合变性13例临床分析  

Clinical Analysis of 13 Patients of Subacute Combined Degeneration Positive for Intrinsic Factor and/or Antiparietal Cell Antibodies

作　　者：张成杰[1] 陈彬[1] 韩燕飞[1] 孙金梅[1] ZHANG Cheng-jie;CHEN Bin;HAN Yan-fei;SUN Jin-mei(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,北京100050

出　　处：《神经损伤与功能重建》2021年第8期455-458,共4页Neural Injury and Functional Reconstruction

基　　金：国家自然科学基金(No.81801334)。

摘　　要：目的:探讨内因子抗体和(或)抗胃壁细胞抗体阳性的脊髓亚急性联合变性(SCD)患者的临床特点、辅助检查、胃镜结果、治疗及预后。方法:回顾性分析内因子抗体和(或)抗胃壁细胞抗体阳性的SCD患者13例的临床特点、血常规和维生素B_(12)(Vit B_(12))水平、神经电生理、脑和脊髓核磁、胃镜、治疗及预后情况。结果:13例患者中亚急性起病7例,慢性起病6例。仅完善内因子抗体检测6例,结果均为阳性;同时检测内因子抗体和抗胃壁细胞抗体7例,其中仅抗胃壁细胞抗体阳性4例,二者均为阳性3例。5例患者伴有Vit B_(12)缺乏的其他原因。10例患者存在脊髓后索、侧索和周围神经均受累的症状和体征。5例患者存在巨幼细胞性贫血,1例患者为正细胞性贫血。7例患者Vit B_(12)水平下降,包括1例患者10月前检测的Vit B_(12)水平下降。12例患者行神经传导速度检查,9例提示周围神经损伤。12例患者行脊髓磁共振检查,4例异常。5例患者行胃镜检查,2例提示慢性萎缩性胃炎,3例提示慢性浅表性胃炎。所有患者均给予腺苷钴胺或甲钴胺肌肉注射,住院治疗2~3周后,12例患者症状有所改善。结论:内因子抗体和(或)抗胃壁细胞抗体阳性的SCD患者可同时伴有引起Vit B_(12)缺乏的其他原因。其临床症状和体征以脊髓后索、侧索和周围神经同时受累为主。脊髓核磁检查可显示病灶情况,但阳性率不高。内因子抗体和(或)抗胃壁细胞抗体阳性的SCD患者应进一步行胃镜检查评估胃部病变情况。尽早肌肉注射补充Vit B_(12)有助于改善预后。Objective:To explore the clinical features,supplementary examination,gastroscope results,treatment,and prognosis of patients with subacute combined degeneration(SCD)of the spinal cord who are positive for antibodies against intrinsic factor and/or parietal cells.Method:We retrospectively analyzed the clinical features,routine blood test,vitamin B_(12)(VitB_(12))level,neurophysiological features,brain and spine MRI features,endoscopy results,treatment,and prognosis of 13 SCD patients with positive antibodies against intrinsic factor and/or parietal cells.Results:Among the 13 patients,7 presented subacute and 6 displayed chronic disease onset.Six patients were tested for antibodies only against intrinsic factor,and all were positive.Seven patients were tested for antibodies against both intrinsic factor and parietal cells;4 were positive for antiparietal cell antibodies,and 3 were positive for both antibodies.Five patients had other concurrent causes of VitB_(12) deficiency.Ten patients presented with clinical symptoms and signs of impairment of the posterior and lateral columns and peripheral nerves.Five patients had megaloblastic anemia,and 1 had normocytic anemia.The VitB_(12) levels were low in7 patients,1 of whom showed a low VitB_(12) level 10 months ago.Nerve conduction velocities were examined in12 patients,and 9 patients had peripheral nerve injury.MRI examination of the spinal cord was performed in 12 patients,and 4 patients showed abnormal signs.Five patients underwent gastroscopy,and chronic atrophic gastritis was found in 2 patients and chronic superficial gastritis in 3.All patients were treated with intramuscular injections of cobalamin adenosine or mecobalamin,and symptoms were improved in 12 patients after 2 to 3 weeks of inpatient treatment.Conclusion:Patients of SCD with positive antibodies against intrinsic factor and/or parietal cells may experience other accompanying causes of VitB_(12) deficiency.Patients mainly present with clinical symptoms and signs of impairment involving the posterior an

关 键 词：脊髓亚急性联合变性 内因子抗体 抗胃壁细胞抗体 维生素B_(12) 磁共振成像 胃镜 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学]