中枢神经系统不典型的结核感染与视神经脊髓炎13例临床分析

目的 研究视神经脊髓炎(NMO)的发病是否与结核感染密切相关,抗结核治疗是否能够达到治疗该病的目的.方法 对激素冲击治疗无效的13例NMO患者进行前瞻性研究,应用EDSS对患者的伤残程度进行评分,巢式PCR扩增脑脊液中结核杆菌特异性的MPB-64靶基因.进行抗结核诊断性治疗,并进行长期随访和观察.结果 治疗前EDSS评分在4.5～9,10例患者脑脊液常规检查有异常,巢式PCR有3个患者有阳性结果.治疗后13例患者EDSS评分逐步下降,视力改善,脊髓内的异常信号在治疗后逐渐消退,患者对抗结核治疗反应良好.结论 结核感染可能是视神经脊髓炎的主要病因,神经系统不典型的结核感染可能是该病造成脊髓和视神经损害的重要途径.鉴于该病预后差,以及抗结核治疗在本研究中的效果,作者认为在原因不明时,应为患者及早进行诊断性抗结核治疗.

Atypical tuberculous infection of central nervous system and Devic's neuromyelitis optica: a clinical and pathological study of 13 cases

Objective To investigate the correlation between neuromyelitis optica(NMO)and tuberculous infection,to confirm whether central nervous system(CNS)infection is involved,and to test whether antituberculous chemotherapy can cure NMO.Methods Thirteen NMO patients who failed to recover after treatment with high dose corticosteroids underwent trial chemotherapy against tuberculosis without concomitant immunosuppressive treatment.Disability was scored by means of expanded disability status scale(EDSS).Cerebrospinal fluid samples were collected to undergo MPB64-targeted nested PCR to test Mycobacterium tuberculosis and magnetic resonance imaging changes were evaluated before and after treatment,long-term observations were followed up.Resuits Antimycobacterial therapy leaded to important neurological recovery.Visual acuity was improved markedly,most abnormal signals in spinal cord disappeared during the follow-up,and the EDSS score decreased after the treatment even to 3 from pretreatment scores(such as 9).Nested PCR to test M.tuberculosis was positive in 3 patients.After antituberculous chemotherapy all the patients showed an excellent response, Conclusions Tuberculous infection may be the main cause of NMO.Direct CNS tuberculous infection is involved in the pathogenesis.Antituberculous chemotherapy is beneficial for the patients failing to respond to corticosteroid treatment.