脊髓亚急性联合变性40例临床分析  

Clinical analysis on 40 patients with subacute combined degeneration of the spinal cord

作　　者：安红 秦伟[1] 孟祥龙[2] 鲁明 董谦[1] 胡文立[1] AN Hong;QIN Wei;MENG Xiang-long;LU Ming;DONG Qian;HU Wen-li(Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Orthopaedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,北京100020 [2]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《河北医科大学学报》2025年第3期298-303,共6页Journal of Hebei Medical University

基　　金：国家自然科学基金(62276173)。

摘　　要：目的探讨脊髓亚急性联合变性(subacute combined degeneration,SCD)的病因、临床特征、实验室检查及影像学特点。方法回顾性分析自2015年5月-2022年10月经我科诊断为SCD的患者临床资料。其中男性22例,女性18例。根据病因分为维生素B12缺乏组及一氧化二氮(nitrous oxide,N_(2)O)滥用组。维生素B12缺乏组34例,N 2O滥用组6例。结果SCD病程呈亚急性或慢性。多数患者以感觉异常和(或)肢体无力起病,部分患者出现认知障碍,且认知障碍在N 2O滥用组更为突出。多数SCD患者实验室检查可显示维生素B12减低,伴叶酸减低、巨幼细胞贫血、高同型半胱氨酸血症、抗内因子抗体或抗胃壁细胞抗体阳性。脊髓MRI显示病灶多累及颈髓及胸髓的后索及侧索,典型的病灶在T2WI轴位上呈“倒V征”。经治疗后,多数患者症状及体征改善。结论脊髓亚急性联合变性是一种与维生素B12缺乏密切相关的疾病。N_(2)O滥用是青年SCD患者的常见病因。该病临床表现复杂多样,脊髓“倒V”征是确诊的重要依据,早期诊断及规范治疗是获得良好预后的关键。Objective To investigate the etiology,clinical features,laboratory examinations and imaging characteristics of subacute combined degeneration(SCD)of the spinal cord.Methods Clinical data of patients diagnosed with SCD in our department from May 2015 to October 2022 were analyzed retrospectively.In this study,22 males and 18 females were included.According to the etiology,the patients were divided into vitamin B12 deficiency group(n=34)and nitrous oxide(N 2O)abuse group(n=6).Results The clinical course of SCD was subacute or chronic.Most patients began with paresthesia and/or limb weakness.Cognitive impairment occurred in a small number of patients and was more significant in N_(2)O abuse group.Laboratory tests showed decreased vitamin B12 level in most patients,accompanied by decreased folate,megaloblastic anemia,hyperhomocysteinemia,and positive anti-internal factor antibodies or anti-parietal cell antibodies.Spinal MRI revealed that the lesions mostly involved the posterior and lateral cord of cervical and thoracic spinal cord,which was characterized by an"inverted V sign"on the axial T2WI.Most patients achieved improvement in symptoms and signs after vitamin B12 treatment.Conclusion SCD of the spinal cord is closely related to vitamin B12 deficiency.N_(2)O abuse is a common cause in young patients with SCD.The clinical manifestations of SCD are complicated and varied,and spinal"inverted V sign"is an important evidence for diagnosis.Early diagnosis and standard treatment are the key to obtaining a good prognosis.

关 键 词：脊髓亚急性联合变性 维生素B12 一氧化二氮 

分 类 号：R744.6[医药卫生—神经病学与精神病学]