脊髓亚急性联合变性患者血清维生素B_(12)水平与临床表现的分析

目的探讨脊髓亚急性联合变性(SCD)患者的血清维生素B_(12)水平(正常或降低)与临床表现间的关系。方法回顾性分析18例血清维生素B_(12)水平降低的SCD患者(维生素B_(12)降低组)和12例维生素B_(12)水平正常或升高的SCD患者(维生素B_(12)正常组)的临床资料,比较两组在临床表现、血液学、电生理、影像及维生素B_(12)治疗效果方面的差异。结果 1维生素B_(12)降低组患者肌力较维生素B_(12)正常组显著减退(P=0.002);2维生素B_(12)降低组同型半胱氨酸(Hcy)平均值较正常组高,且Hcy升高比例高于维生素B_(12)正常组(P=0.020);3维生素B_(12)降低组的体感诱发电位异常率高于维生素B_(12)正常组(P=0.044);4两组脊髓MRI阳性发现率差异无显著性;5维生素B_(12)降低组对维生素B_(12)治疗效果好于维生素B_(12)正常组(P=0.006)。结论血清维生素B_(12)水平降低的SCD患者较维生素B_(12)水平正常患者病情更为严重;维生素B_(12)水平降低患者应用维生素B_(12)治疗的效果更好;血清维生素B_(12)降低不是诊断SCD的必要条件;高Hcy并非一项理想的SCD诊断指标;SCD的预后、疗效与病程有关,早期诊断、及时治疗至关重要。

Clinical Analysis of Patients with Subacute Combined Degeneration in Different Serum Vitamin B12 Levels

ABSTRACT Aim To study the relationship between serum levels of vitamin B12 (normal or decreased) and clinical manifestations in patients with subacute combined degeneration of spinal cord (SCD). Methods A retrospective analysis of 18 SCD patients with low serum vitaminB12 (decreased group for short), and 12 SCD patients with normal or elevated serum vitaminB12 (normal group for short), compared and analyzed the clinical features, hematology, electro-physiological findings, imaging findings and the therapeutic reaction to vitaminB12 of the two groups.Results①The patients’ muscle strength of the decreased group significantly decreased than that of the normal group (P=0.002).②The average value of homocysteine (Hcy) in decreased group was higher than that in the normal group, and the proportion of elevatory Hcy was higher than that in the normal group (P=0.020).③The abnormal rate of c in the decreased group was higher than that in the normal group (P=0.044).④There was no signiifcant difference in the positive rate of spinal cord MRI between the two groups.⑤The therapeutic reaction to vitaminB12 of the decreased group was better than that in the normal group (P=0.006).ConclusionThe patients’ conditions of the decreased group was more serious than that in the normal group. The therapeutic reaction to vitaminB12 was better in the decreased group than in the normal group. The reduction of serum vitaminB12 was not necessary for the diagnosis of SCD. Hcy was not an ideal index for the diagnosis of SCD. The prognosis and curative effect of SCD correlated with the course. Early diagnosis and prompt treatment was essential.