多发性硬化与视神经脊髓炎临床对比研究

目的 比较多发性硬化(MS)与视神经脊髓炎(NMO)国人的临床特点,提高临床鉴别诊断能力.方法 对两组患者发病年龄、起病形式、首发症状、临床症候及电生理、实验室及影像检查等对比分析.结果 MS男女比例1:1.35,而NMO为1:4.43,后者女性更多见;MS发病平均35.5岁,而NMO为30.6岁,两者差异无统计学意义.NMO视力下降至≤0.1为13例,显著高于MS(1例),前者(19例)治疗后视力仍≤0.5者显著多于后者(1例).MS智能减退者(10例)显著较NMO(3例)更为多见.MS脑脊液寡克隆带阳性者(16例)显著多于NMO(9例).MS脊髓病灶形态以卵圆形居多,多靠周边且不对称,而NMO则以纵向融合及居中病灶多见;MS的脊髓受累平均节段为2.17个,显著少于NMO的6.60个,而其脊髓病灶数为1.96个,显著多于NMO的1.17个.结论 NMO可能是不同于MS的疾病实体,两者人群易感性、临床特点、影像表现等均有所不同.

A clinical comparative study of multiple sclerosis and neuromyelitis optica

Objective To compare the clinical characteristics of multiple sclerosis ( MS) and neuromyelitis optica (NMO) for better diagnosis and differential diagnosis of them. Methods The characteristics of 40 MS and 38 NMO cases were retrospectively studied on clinic manifestations, electroneurophysiology,some laboratory indices, imaging characteristics and so on. Results The ratios of male to female were 1: 1. 35 and 1:4. 43 respectively in patients with MS and NMO, so patients with NMO were more likely to be female as compared with MS ( P < 0. 05 ). The mean onset age was ( 35. 5 ±13. 9 ) years in MS patients and (30. 6 ± 15. 6) years in NMO patients, but no significant difference was found (P>0. 05). The cases of visual acuity ≤0.1 in patients NMO was 13, which of MS was merely 1. The cases of visual acuity less than 0. 5 after treatment in NMO patients was 19, which in MS was only 1. The cases of cognitive impairment in NMO was 3, which of MS was 10. The cases of cerebrospinal fluid oligoclonal bands in MS was 16, which in NMO patients was 9. The lesions of spinal cord shown in MRI of MS patients were typically oval, peripheral and asymmetric, but those in NMO patients extended longitudinally and converged centrally. The mean number of involved vertebral segments in NMO patients was significantly greater than that in MS patients ( 6. 6 vs 2. 2, P < 0. 01). Furthermore, the number of spinal cord lesions in MS patients was alse remarkably greater than that in NMO patients (2. 0vs1.2, P <0. 01). Conclusions NMO may be a distinct clinical entity, which is likely to be differentiated from MS by its tendency to affect women, younger age at onset, and other features clinical manifestations, electroneurophysiology, laboratory parameters, neuroimaging show..