| 张成杰，陈彬，韩燕飞，孙金梅.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[J].神经损伤功能重建,2021,16(8):455-458 |
| 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 Fac⁃tor and/or Antiparietal Cell Antibodies |
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| DOI： |
| 中文关键词: 脊髓亚急性联合变性 内因子抗体 抗胃壁细胞抗体 维生素B12 磁共振成像 胃镜 |
| 英文关键词: subacute combined degeneration intrinsic factor antibody antiparietal cell antibody vitamin B12 MRI gastroscopy |
| 基金项目:国家自然科学基
金（No. 81801334） |
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| 中文摘要: |
| 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B12（VitB12）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VitB12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VitB12水平下降，包括1例患者10月前检测的VitB12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VitB12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VitB12有助于改善预后。 |
| 英文摘要: |
| 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 B12 (VitB12) 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 VitB12 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 VitB12 levels were low in
7 patients, 1 of whom showed a low VitB12 level 10 months ago. Nerve conduction velocities were examined in
12 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 VitB12 deficiency. Patients mainly present with clinical symptoms and signs of impairment involving the posterior and lateral columns and peripheral nerves. MRI examination of the spinal cord can show abnormal signs, though with a low positive rate. Gastroscopy should be performed in the SCD patients with positive antibodies against intrinsic factor and/or parietal cells. Early intramuscular injection of VitB12 is helpful for improving prognosis. |
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