| 李恒宇，陈浩，徐凯，叶新春，董丽果，张沈阳，崔桂云.107例脊髓亚急性联合变性患者的临床特征分析[J].神经损伤功能重建,2018,13(9):456-459 |
| 107例脊髓亚急性联合变性患者的临床特征分析 |
| Analysis of Clinical Characteristics in 107 Patients with Subacute Combined Degeneration ofSpinal Cord |
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| DOI： |
| 中文关键词: 脊髓亚急性联合变性 临床特征 VitB12缺乏 高同型半胱氨酸 周围神经病变 |
| 英文关键词: subacute combined degeneration of spinal cord clinical features VitB12 deficiency hyperhomocysteinemia peripheral neuropathy |
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| 中文摘要: |
| 目的：探讨脊髓亚急性联合变性的临床、影像及电生理特征。方法：回顾性分析107例脊髓亚急性联
合变性住院患者的临床资料，总结其临床、影像及电生理特点。结果：本组患者起病年龄从21~87岁，男性
显著多于女性（P<0.05）。临床表现以行走不稳最多见（76.6%），其次为双下肢麻木和/或无力（47.7%），四肢
麻木和/或无力排在第三位（26.2%）；伴随症状中头晕最多见（19.6%），尿便障碍（9.3%），也可有视力减退、反
应迟钝等。巨幼细胞贫血较VitB12血清浓度降低检出率高（P=0.041），二者吻合度一般（Kappa=0.512）；同
型半胱氨酸血浆浓度增高较巨幼细胞贫血意义更大（P=0.00），二者吻合度一般（Kappa=0.567）。脊髓及颅
脑常规 MRI 阳性检出率 56.1%，病变易发于脊髓 C2～C7 及 T1～T4 节段。神经电生理阳性检出率 79.8%
（75/94），其中脊髓病变合并周围神经病变47例，单纯周围神经病变25例。结论：脊髓亚急性联合变性临床
表现复杂多样，血清VitB12浓度可能掩盖病情，而高同型半胱氨酸血浆浓度有更大的提示作用，二者的血液
度变化同巨幼细胞贫血在疾病不同阶段时常不平行。 |
| 英文摘要: |
| To analyze the clinical, electrophysiological and imaging features of subacute combined
degeneration of spinal cord. Methods: A retrospective study was performed on the clinical data of 107
inpatients with subacute combined degeneration of spinal cord in which clinical, electrophysiological, and
imaging features were summed up and analyzed. Results: The age of onset was 21~87 years, and male patients
significantly outnumber female patients (P<0.05). Instability in gait was the most common clinical manifestation
(76.6%) followed by numbness and/or weakness in both lower limbs (47.7%) and numbness and/or weakness in
the extremities (29.0%). Among the concomitant symptoms, the most common was dizziness (19.6%) followed
by urinary disturbance (9.3%), and vision loss and decreased responsiveness were also observed. Detection rate
of megaloblastic anemia was significantly higher than that of serum VitB12 concentration decrease (P=0.041),
and the degree of coincidence was medium (Kappa=0.512). Increased serum homocysteine concentration yielded
a more significantly higher detection rate than that of megaloblastic anemia (P=0.00); the degree of coincidence
was medium (Kappa=0.567). The positive detection rate of MRI findings of the spinal cord and brain was 56.1%.
The lesions were prone to occurring at the C2~C7 and T1~T4 segments of the spinal cord. Positive detection rate
of electrophysiology was 79.8% (75/94), including 47 cases of spinal cord disease complicated with peripheral
neuropathy and 25 cases with peripheral neuropathy alone. Conclusion: The clinical manifestations of subacute
combined degeneration of spinal cord are complex. Serum vitamin B12 concentration may conceal the condition
while a high level of homocysteine may offer a more significant role in detection; changes in blood concentration
of both elements often do not parallel megaloblastic anemia at different stages of the disease. |
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