107例脊髓亚急性联合变性患者的临床特征分析

目的:探讨脊髓亚急性联合变性的临床、影像及电生理特征。方法:回顾性分析107例脊髓亚急性联合变性住院患者的临床资料,总结其临床、影像及电生理特点。结果:本组患者起病年龄从21~87岁,男性显著多于女性(P0.05)。临床表现以行走不稳最多见(76.6%),其次为双下肢麻木和/或无力(47.7%),四肢麻木和/或无力排在第三位(26.2%);伴随症状中头晕最多见(19.6%),尿便障碍(9.3%),也可有视力减退、反应迟钝等。巨幼细胞贫血较VitB12血清浓度降低检出率高(P=0.041),二者吻合度一般(Kappa=0.512);同型半胱氨酸血浆浓度增高较巨幼细胞贫血意义更大(P=0.00),二者吻合度一般(Kappa=0.567)。脊髓及颅脑常规MRI阳性检出率56.1%,病变易发于脊髓C2~C7及T1~T4节段。神经电生理阳性检出率79.8%(75/94),其中脊髓病变合并周围神经病变47例,单纯周围神经病变25例。结论:脊髓亚急性联合变性临床表现复杂多样,血清VitB12浓度可能掩盖病情,而高同型半胱氨酸血浆浓度有更大的提示作用,二者的血液度变化同巨幼细胞贫血在疾病不同阶段时常不平行。

Analysis of Clinical Characteristics in 107 Patients with Subacute Combined Degeneration ofSpinal Cord

To analyze the clinical, electrophysiological and imaging features of subacute combineddegeneration of spinal cord. Methods: A retrospective study was performed on the clinical data of 107inpatients with subacute combined degeneration of spinal cord in which clinical, electrophysiological, andimaging features were summed up and analyzed. Results: The age of onset was 21~87 years, and male patientssignificantly outnumber female patients (P<0.05). Instability in gait was the most common clinical manifestation(76.6%) followed by numbness and/or weakness in both lower limbs (47.7%) and numbness and/or weakness inthe extremities (29.0%). Among the concomitant symptoms, the most common was dizziness (19.6%) followedby urinary disturbance (9.3%), and vision loss and decreased responsiveness were also observed. Detection rateof megaloblastic anemia was significantly higher than that of serum VitB12 concentration decrease (P=0.041),and the degree of coincidence was medium (Kappa=0.512). Increased serum homocysteine concentration yieldeda more significantly higher detection rate than that of megaloblastic anemia (P=0.00); the degree of coincidencewas medium (Kappa=0.567). The positive detection rate of MRI findings of the spinal cord and brain was 56.1%.The lesions were prone to occurring at the C2~C7 and T1~T4 segments of the spinal cord. Positive detection rateof electrophysiology was 79.8% (75/94), including 47 cases of spinal cord disease complicated with peripheralneuropathy and 25 cases with peripheral neuropathy alone. Conclusion: The clinical manifestations of subacutecombined degeneration of spinal cord are complex. Serum vitamin B12 concentration may conceal the conditionwhile a high level of homocysteine may offer a more significant role in detection; changes in blood concentrationof both elements often do not parallel megaloblastic anemia at different stages of the disease.