多发性硬化的周围神经系统损害

多发性硬化(MS)是一种中枢神经系统(CNS)脱髓鞘性疾病,近年来,国外许多病理及电生理学研究结果显示,其可以合并周围神经系统(PNS)损害门.最近,谢淑萍等报道了国内首例,由病理证实合并有周围     

多发性硬化患者的护理

目的 总结多发性硬化患者的临床护理要点.方法 回顾性分析132例临床确诊多发性硬化患者的临床资料和护理方法 .结果 对多发性硬化患者的临床护理特点包括基础护理、心理护理、康复训练、严密观察药物反应及饮食指导、出院指导等,针对患者的不同病情进行不同的临床护理,有利于患者治疗方案的执行以及促进病情的稳定和好转,防治并发症的发生.结论 有效的个体化护理措施可以促进多发性硬化患者病情的稳定和好转,减少复发次数,延缓病情进展,提高生活质量.     

多发性硬化周围神经损害的临床与神经电生理分析

目的探讨多发性硬化（MS）患者合并周围神经损害的的临床和神经电生理特点。方法分析41例MS患者周围神经损害的临床，同时采用神经传导速度（NCV）技术检测MS患者周围神经的运动传导速度（MCV）、感觉传导速度（SCV）及其潜伏期、波幅；检测正中神经、胫神经F波、H反射的潜伏期和F波的出现率。结果MS合并PNS损害的发生率为41．4％，其临床表现主要为肢体麻木12例（29．2％）、肢体乏力10例（24．3％）、神经根性疼痛2例（4．8％）；体征有末梢／根型感觉障碍9例（21．9%）、腱反射减低5例（12．1％）、肌力减低（〈Ⅳ级）5例（12．1%）、肌萎缩3例（7．3%）。神经电生理改变为F波、H反射潜伏期延长，F波的出现率下降；神经电位波幅降低；不同程度运动感觉神经传导速度减慢及末端潜伏期延长。结论MS是一种以CNS受损为主的脱髓鞘疾病，部分患者可以同时累及PNS，神经电生理检测可对周围神经损害进行定位，同时可定量反映周围神经病变的程度。     

大剂量丙种球蛋白治疗多发性硬化的护理

多发性硬化（MS）是以中枢神经系统白质的脱髓鞘病变为特点的自身免疫性疾病，可能在遗传和环境因素的影响下，通过变态反应性免疫障碍而发病。近5年来江苏省扬州市第一人民医院竹西医院神经科采用大剂量丙种球蛋白治疗部分多发性硬化患者10例，取得了较好的疗效。     

症状不典型多发性硬化1例的护理

多发性硬化( multiple sclerosis MS)是一种以中枢神经系统脱髓鞘为主要病理改变的自身免疫性疾病.临床表现复杂多样,因此对患者的护理也应当个体化.本文就我科收住的1例症状不典型的多发性硬化患者的护理体会汇报如下.     

1例多发性硬化病人的护理

多发性硬化(multipre sclerosis,MS)是中枢神经系统原发性脱髓鞘性疾病,其临床特点是中枢神经系统多部位受损,病灶弥散,病程中有反复缓解或复发。2012年12月我科收治1例多发性硬化病人,现将护理总结如下。1病例介绍病人,女,41岁,因右眼视力进行性减退伴头痛、记忆力减退20余天收入院,病人20余天前出现右眼视力进行性减退伴     

5例多发性硬化患儿的护理

总结5例多发性硬化患儿的临床护理经验。根据多发性硬化在时间、空间上的复发与进展的特性,在护理中积极关注心理护理,密切观察病情变化;做好对症护理,包括惊厥的防护及急救,头痛、呕吐的患儿予舒适的体位及安静环境,肢体活动障碍及视力障碍时予24h陪护;加强安全防护及生活护理,重视出院指导,避免复发因素。本组3例患儿复发2次,1例复发3次,1例复发5次,共住院14次,无护理并发症,神经系统症状消失后。病情好转出院。     

67例多发性硬化患者视神经损害的临床分析

视神经损害在多发性硬化(MS)患者中较为多见,我们在近10年内共收治MS102例,其中视神经损害67例(占65.69％),现报告如下。 1 临床资料 1.1 诊断标准:根据日本厚生省MS研究组重新制定的诊断标准:①好发于15～50岁;②呈中枢神经的多灶性症状;③缓解—复发病程;④排除其它疾病。     

青年多发性硬化1例的护理

我院于2008—09成功护理1例多发性硬化的青年患者，在治疗过程中护理人员根据病情提供相应的护理措施，使患者正确看待自身疾病重返社会。现将护理体会介绍如下。     

护理干预对多发性硬化病人免疫调节治疗依从性的影响

[目的]提高多发性硬化病人免疫治疗的依从性。[方法]将40例接受免疫调节治疗的多发性硬化病人随机分为实验组和对照组各20例,实验组实施一系列护理干预,对照组给予常规护理,于用药12个月后对两组病人进行遵医行为调查。[结果]实验组有14例能完全遵医,占70%,对照组11例病人能完全遵医,占55%,经比较差异有统计学意义。[结论]护理干预可提高多发性硬化病人免疫治疗的依从性。     

Daclizumab for the treatment of relapsing-remitting multiple sclerosis

Introduction: Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system. Over the last two decades, the number of therapeutic options for the treatment of relapsing remitting MS (RRMS) has been constantly growing, providing new treatment options to patients.

Areas covered: Herein, the authors review the recently approved monoclonal antibody daclizumab for the treatment of RRMS. Based on original articles, they discuss its mode of action and evaluate its efficacy and safety profile compared to other available agents.

Expert opinion: The IL-2 receptor modulator daclizumab is a new highly effective agent for the treatment of RRMS with novel immunomodulatory properties. Compared to interferon-beta i.m., daclizumab is more effective in reducing relapse rates and MRI activity. However, its use is limited by the risk of autoimmune disorders and hepatotoxicity. Similar to other monoclonal antibodies for RRMS, therapy with daclizumab needs a strict preselection and monitoring of patients based on individual risk benefit assessment. Given its substantial effectiveness, daclizumab can be an attractive option for patients with highly active MS.     

The meaning of fatigue for women with multiple sclerosis

AIM: This paper reports the findings of a study that aimed to elucidate the meaning of fatigue for women with multiple sclerosis (MS). BACKGROUND: Living with chronic illness can involve giving up usual activities. MS is a chronic autoimmune disease of the central nervous system. Fatigue is a common experience among people with MS; however, little is known about the meaning of fatigue experienced by women with this condition. METHOD: Ten women with MS were interviewed about their experience of fatigue. A phenomenological hermeneutic method influenced by Ricoeur was used to interpret the transcribed interviews. FINDINGS: The findings were presented in two major themes with five subthemes; experiencing the body as a barrier and experiencing a different absence. Fatigue seemed to give rise to an experience of being absent and divided into two parts. This also led to a feeling of not being able to participate in the surrounding world. The feeling of being an outsider and lacking the ability as a healthy person is interpreted as a form of suffering. Although the fatigue had a great impact on the women's daily life, the women still hoped for some relief. Fatigue seemed to imply that instead of working as an implement to manage in the world the body has become an enemy of survival. CONCLUSION: This study highlights the importance for nurses of understanding how women with MS experience fatigue, which is a prerequisite for communication based on a shared understanding. This awareness would enhance nurses' opportunities to alleviate suffering. More research is needed to investigate what kinds of interventions can help these women to manage their everyday lives and to maintain a sense of normality despite their fatigue and illness. Such interventions should be subject to empirical evaluation research.     

影像组学在多发性硬化中的研究进展

多发性硬化（MS）是自身特异性免疫介导的中枢神经系统脱髓鞘疾病,是青壮年人群最常见的致残性神经系统疾病之一,精准诊断、及时治疗对改善患者长期预后至关重要。影像组学是新兴的精准影像分析技术,能从影像大数据中提取高通量影像特征从而进行定量分析,近年来已逐渐应用于分析MS的病理损伤、诊断、鉴别诊断及预后预测等多个方面。本文就影像组学在MS的研究进展进行综述。     

多序列MRI评估复发缓解型多发性硬化患者大脑皮层厚度改变

目的 观察多序列MRI所示复发缓解型多发性硬化(RRMS)患者大脑皮层厚度改变,并探讨其与皮层病灶及认知功能损害之间的相关性。方法 纳入41例RRMS患者(RRMS组)及30名健康人(对照组),比较其数字广度测验(DST)及符号数字转换测验(SDMT)评分。基于颅脑3D-T1W、液体衰减反转恢复(FLAIR)及双反转恢复(DIR)序列获取2组颅脑体积、皮层厚度及RRMS组皮层病灶数量和体积,分析RRMS组皮层厚度与皮层病灶数量、病灶体积及临床认知量表评分的相关性。结果 RRMS组DST及SDMT评分均低于对照组(P均<0.05),灰质体积小于对照组(P<0.05),白质体积大于对照组(P<0.05)。于36例(36/41,87.80%)RRMS共检出186个皮层病灶,总体积为16 880 mm³。相比对照组,RRMS组皮层萎缩范围更广(P均<0.05),主要集中于额叶和颞叶,且部分脑区皮层萎缩与皮层病灶数量、体积及DST评分具有相关性(P均<0.05)。结论 RRMS患者存在广泛大脑皮层萎缩,并与皮层病灶数量、体积及认知功能损害存在相关性。     

复发缓解型多发性硬化患者扣带皮层结构和灌注变化

目的观察复发缓解型多发性硬化(RRMS)患者扣带皮层各亚区结构和灌注改变及其与认知评分的相关性,探讨扣带皮层亚区结构及灌注改变对RRMS患者认知功能的影响。方法对28例RRMS患者(MS组)和28名健康对照者(对照组)采集头颅3D-T1WI和3D伪连续动脉自旋标记(3D pCASL)序列图像,并进行认知评分;比较2组间双侧扣带皮层8个亚区皮层厚度和脑血流量(CBF),分析MRI参数与认知评分之间的相关性。结果相比对照组,MS组左侧前扣带皮层尾部、左侧和右侧扣带皮层峡部及后扣带皮层CBF值均减低(t=-2.28、-2.95、-2.13、-2.66、-2.04,P均<0.05),左侧和右侧扣带皮层峡部及左侧后扣带皮层变薄,右侧前扣带皮层喙部皮层厚度值增高(t=-3.01、-3.05、-2.41、2.07,P均<0.05);且认知评分均减低(P均<0.01)。MS组认知评分与扣带皮层部分亚区CBF值及皮层厚度存在相关性(P均<0.05)。结论 RRMS患者扣带皮层部分亚区出现的萎缩和灌注改变可能导致认知功能损害。     

1例复发缓解型多发性硬化MRI连贯分析

患者,男性,26岁,因头晕不适月余于2009年3月来我院就诊,查体、神经生理学检查未见明显阳性体征,EDSS评分为0。体温36.9℃,脉搏72次/分,呼吸18次/分,血压110/65mmHg。实验室检查未见明显异常。     

甲状腺激素联合磁共振弥散加权成像评价复发-缓解型多发性硬化临床病程的价值

目的:探讨甲状腺激素测定联合磁共振弥散加权成像在评价复发-缓解型多发性硬化(MS)患者病情中的价值。方法:回顾性分析经临床确诊的复发-缓解型MS患者的临床资料,分为急性发作组和缓解组,另纳入健康体检者作为对照组。分析各组间TSH、fT_3、T_3、fT_4、T_4和甲状腺自身抗体(ATA)间的差异,同时分析急性发作组和缓解组总的MS、DWI高信号病灶间的差异,并分析DWI高信号病灶负荷与甲状腺激素间的相关性。结果:51例复发-缓解型MS患者共发现757个MS病灶,急性发作组和缓解组间年龄、性别及总MS病灶数差异无统计学意义。急性发作组患者病程要短于缓解组(P=0.003)。急性发作组患者fT_3、T_3、TSH水平均低于缓解组和对照组(P0.05),急性发作组患者fT_4水平低于对照组(P=0.015),而相对于缓解组有降低趋势(P=0.072)。缓解组患者TSH水平相对于对照组有降低趋势(P=0.091)。急性发作组患者ATA阳性率高于对照组(P=0.044),缓解组ATA阳性率较对照组有增高趋势(P=0.09)。急性发作组患者出现DWI阳性病灶的比例高于缓解组(P=0.002)。急性发作组患者DWI阳性病灶负荷大于缓解组(P=0.001)。DWI阳性病灶负荷与fT_3负相关(r=-0.332,P=0.097)。结论:甲状腺激素联合DWI有助于临床评价复发-缓解型MS病程。     

Effectiveness of interferon beta treatment in relapsing-remitting multiple sclerosis: an Italian cohort study

RATIONALE, AIMS AND OBJECTIVES: Randomized clinical trials (RCTs) have provided evidence for the efficacy of interferon beta (IFNbeta) in the treatment of relapsing-remitting multiple sclerosis (RRMS). The aim of this study was to evaluate the effectiveness of IFNbeta treatment in clinical practice. METHODS: This was a national, multicentre, observational study of patients with confirmed RRMS. Demographic, clinical and therapeutic data were retrospectively collected for each patient enrolled in the study. RESULTS: The study cohort consisted of 427 patients exposed to and 245 never exposed to IFNbeta treatment during the study period (for a total 2297 patient-years of follow-up). Among the exposed patients, 215 were initially untreated and then began IFNbeta later in the follow-up period; 137 of these patients were exposed to IFNbeta for more than 2 years. In these patients, IFNbeta treatment reduced the mean relapse rate by 24.2%[95% confidence interval (CI): 5.8-42.5%]. For 640 of the 672 patients enrolled in the study, it was possible to calculate the area under the disability/time curve compared to that present at baseline. A total of 117 (18.3%) patients displayed disability progression. Adjustment of the disability progression rates for potential confounders and/or for propensity scores by Poisson regression model resulted in relative risks for patients exposed to IFNbeta treatment compared to those never exposed to IFNbeta of 0.87 (95% CI: 0.56-1.34) after an exposure of < or = 2 years, and of 0.35 (95% CI: 0.21-0.60) after an exposure of >2 years. CONCLUSIONS: These findings suggest that the evidence from RCTs on the treatment of RRMS with IFNbeta has been effectively translated into routine clinical practice.     

复发缓解型多发性硬化患者深部灰质核团体积和灌注改变与临床评分的相关性

目的 采用基于体素的形态学（VBM）方法及3D伪连续动脉自旋标记（3D pCASL）技术探讨复发-缓解型多发性硬化（RRMS）患者深部灰质体积和灌注改变,及其与临床扩展残疾状态量表（EDSS）和神经心理学量表评分间的相关性。方法 对30例RRMS患者（RRMS组）和24名健康志愿者（对照组）行EDSS量表和神经心理学量表测试,评估其记忆功能。行3D T1WI及3D pCASL扫描,并应用Matlab平台的SPM 8及VBM 8软件对图像进行预处理。采用SPM统计软件,分析RRMS患者深部灰质体积、灌注改变,进一步提取深部灰质体积、灌注显著改变脑区的参数值与EDSS和神经心理学量表评分进行相关性分析。结果 与对照组比较,RRMS组双侧丘脑、左侧海马、左侧壳核、右侧苍白球体积显著下降（P均<0.05,FDR校正）,双侧丘脑、双侧尾状核脑血流量（CBF）显著下降（P<0.05,FDR校正）。RRMS组左右侧丘脑体积、右侧苍白球体积、左侧丘脑CBF与符号数字转换测验评分呈正相关（r_s=0.757、0.709、0.463、0.454,P均<0.05）,左右侧丘脑体积、左侧丘脑CBF与Rey听觉词语学习测试-即刻记忆评分呈正相关（r_s=0.565、0.503、0.492,P均<0.05）,与EDSS评分均无明显相关性（P均>0.05）。结论 RRMS患者深部灰质体积和灌注均发生改变,深部灰质体积和灌注下降均与记忆功能受损有关。