脊髓亚急性联合变性103例临床分析

目的 通过分析总结脊髓亚急性联合变性(SCD)患者的临床特点,提高临床医师对SCD的正确认识和及时诊治。方法 回顾性分析103例于我院确诊的SCD患者的一般病例资料、神经功能缺损情况及相关辅助检查结果。结果 103例患者均有神经功能缺损,46.6%(48/103)患者血红蛋白降低,57.3%(59/103)患者平均红细胞体积降低,60.2%(62/103)患者平均红细胞血红蛋白量降低,55.9%(52/93)患者血清B12降低,46.1%(42/91)患者叶酸水平降低,80.6%(25/31)患者同型半胱氨酸升高,27.0%(10/37)患者脑脊液蛋白升高;神经电生理结果显示73.4%(58/79)患者神经传导检查异常,93.3%(56/60)患者体感诱发电位异常;磁共振成像显示49.4%(41/83)患者发现病灶,病灶多位于胸段、颈段及大脑白质区。结论 SCD临床表现及辅助检查多样化,存在较高的误诊率和漏诊率,综合判定尤为重要。

Clinical analysis of 103 patients with subacute combined spinal core degeneration

Objective By analyzing the clinical characteristics of subacute combined spinal core degenerationin (SCD),to improve recognition and early diagnosis.Methods The general clinical data, nerve function defect situation, and related examination results were collected and analyzed retrospectively in 103 patients with clinically confirmed SCD.Results All 103 patients had nerve function defect. Reduced hemoglobin was found in 48 of 103 cases (46.6%), reduced mean corpuscular volume in 59 of 103 cases(57.3%) and reduced mean corpuscular hemoglobin in 62 of 103 cases(60.2%). The serum vitamin B12 was lower than before the disease onset in 52 of 93 cases (55.9%). 46.1% in 91 patients were observed with the lower folic acid level. Elevated homocysteine and cerebrospinal fluid protein level were observed in 80.6% and 27% patients respectively. 58 of 79 patients(73.4%) showed abnormal changes in electromyography, 93.3% patients(56/60) the abnormal somatosensory evoked potentials (SEP),49.4% of the patients were found lesions by magnetic resonance imaging,the lesions involved thoracic cord, cervical cord and cerebral white matter.Conclusion The clinical manifestations and auxiliary examination of SCD are diversified. The high rate in misdiagnosis existed, comprehensive consideration played an important role in the diagnosis of SCD.