视神经脊髓炎谱系疾病伴脊髓型颈椎病患者临床特征及影像学特点  

Clinical and imaging features of patients with neuromyelitis optica spectrum disease and cervical spondylotic myelopathy

作　　者：赵雪[1,2] 刘煜东 马振申 段瑞生[1,3] ZHAO Xue;LIU Yudong;MA Zhenshen;DUAN Ruisheng(不详;Shandong Provincial Qianfoshan Hospital Affiliated of Shandong University,Shandong Institute of Neuroimmunology,Jinan 250014,China)

机构地区：[1]山东大学附属山东省千佛山医院,250014 [2]聊城市人民医院神经内科 [3]山东省神经免疫研究所,250014

出　　处：《中国神经免疫学和神经病学杂志》2021年第5期381-385,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：山东省自然科学基金资助项目(ZR2020MH142);山东第一医科大学学术提升计划(2019QL013)。

摘　　要：目的探讨伴有脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)患者的临床特征及影像学特点。方法回顾性收集2012年5月至2018年5月山东省千佛山医院收治的NMOSD患者42例,按是否伴有CSM分为伴CSM组(24例)和不伴CSM组(18例),比较两组患者的临床特征及影像学特点的差异。结果与不伴CSM的NMOSD患者比较,伴CSM组平均年龄较大〔(54.8±13.9)岁比(42.8±20.2)岁,P<0.05〕,NMOSD病变累及部位更多(P<0.05),且累及脊髓者比例有增高趋势(87.5%比60.0%),但差异无统计学意义(P=0.063),其中尤以累及颈髓者居多(83.3%比13.3%,P<0.01),伴CSM组累及脊髓节段数更多〔中位数(四分位数间距):4.00(5.75)个比2.00(3.25)个;P<0.01〕,横断面损伤更重〔中位数(四分位数间距):3.00(2.00)期比1.00(2.25)期,P<0.05〕。结论合并CSM的NMOSD患者年龄较大,病灶位于脊髓者居多,以颈髓更易受累,脊髓受压缺血缺氧等损伤可能与NMOSD患者脊髓病灶累及节段数更多、横断面损伤更重有关。Objective To investigate the clinical and imaging characteristics of neuromyelitis optica spectrum disorders(NMOSD)patients with cervical spondylotic myelopathy(CSM).Methods A total of 42 NMOSD patients admitted to Shandong Provincial Qianfoshan Hospital from May 2012 to May 2018 were retrospectively collected and divided into two groups:a group with CSM(24 cases)and a group without CSM(18 cases).The clinical features and the imaging characteristics of each group were analyzed.Results Compared with NMOSD patients without CSM,the average age of the patients with CSM was older[(54.8±13.9)years old vs.(42.8±20.2)years old,P<0.05],the total number of NMOSD lesions was larger(P<0.05),and the proportion of people with spinal cord involvement tended to be increased(87.5%vs.60.0%),but the difference was not statistically significant(P=0.063).Especially the cervical cord involvement was more common in NMOSD patients with CSM(83.3%vs.13.3%,P<0.01).The spinal cord lesions were more severe in NMOSD patients with CSM because of longer injured segments[median(interquartile distance):4.00(5.75)vs.2.00(3.25),P<0.01]and larger cross-sectional area of lesions[median(interquartile distance):3.00(2.00)vs.1.00(2.25),P<0.05].Conclusions NMOSD patients combined with CSM were older,and the lesions were mainly located in the spinal cord,especially the cervical cord.Compression,ischemia,hypoxia and other injuries in spinal cord may be related to more injured segments and more severe cross-sectional lesions in spinal cord in NMOSD patients.

关 键 词：视神经脊髓炎谱系疾病 脊髓型颈椎病 水通道蛋白4 脊髓损伤 临床表现 磁共振成像 

分 类 号：R744.52[医药卫生—神经病学与精神病学]