不同病因致脊髓亚急性联合变性的临床及影像学对比分析

  目的  分析一氧化二氮(nitrous oxide, N₂O)滥用致脊髓亚急性联合变性(subacute combined degeneration, SCD)和非N₂O相关性SCD临床、影像学及预后间的差异。  方法  回顾性分析2017年1月—2021年4月在杭州师范大学附属医院、浙江大学附属邵逸夫医院及浙江大学附属第二医院确诊的43例SCD患者的临床资料。根据病因分为N₂O滥用组(23例)及非N₂O滥用组(20例)。比较2组在临床表现、影像学检查、实验室检查及预后间的差异。  结果  N₂O滥用组的发病年龄[21(19,25)岁]显著低于非N₂O滥用组[69(62,74)岁, P < 0.001]。N₂O滥用组出现尿便功能障碍的概率(34.78%,8/23)较非N₂O滥用组低(65.00%,13/20, P=0.048)。N₂O滥用组出现脊髓肿胀的概率(56.52%, 13/23)较非N₂O滥用组高(20.00%,4/20, P=0.015)。N₂O滥用组入院时的改良Rankin评分量表(mRS)评分[3.0(2.5,4.0)分]较非N₂O滥用组低[4.0(3.5,4.0)分, P=0.033];治疗3个月后的mRS评分[2.0(1.0,2.0)分]也较非N₂O滥用组低[3.0(3.0,4.0)分,P < 0.001]。  结论  与非N₂O滥用组相比,N₂O滥用致SCD的神经功能损伤程度低,发生脊髓肿胀概率高,预后较好。 

Clinical and radiological analysis of subacute combined degeneration caused by different etiologies

  Objective  This study aims to compare the clinical, radiological features and outcomes between patients with subacute combined degeneration (SCD) induced by recreational nitrous oxide (N₂O) abuse and patients with N₂O-unrelated SCD.  Methods  From January 2017 to April 2021, the clinical data of 43 patients with SCD diagnosed at Affiliated Hospital of Hangzhou Normal University, Sir Run Run Shaw Hospital Zhejiang University and Zhejiang Second Hospital were retrospectively analysed. According to the etiology, case data were divided into 23 patients with recreational N₂O-induced SCD and 20 patients with N₂O-unrelated SCD. The clinical and MRI features, laboratory tests and prognosis were compared between the two groups.  Results  Of the 23 patients with recreational N₂O-induced SCD, the mean age of onset was lower than those with N₂O-unrelated SCD [21 (19, 25) vs. 69 (62, 74) years, P < 0.001]]. The incidence of urinary and stool dysfunction was lower in the N₂O-induced SCD group (34.78%, 8/23) than in the N₂O-unrelated SCD group (65.00%, 13/20, P=0.048). MRI examinations indicated the N₂O-induced SCD cases presented a higher incidence of cord swelling [56.52% (13/23) vs. 20.00% (4/20), P=0.015]. The mRS scores for patients with N₂O-induced SCD [3.0 (2.5, 4.0)] were lower than those with N₂O-unrelated SCD [4.0 (3.5, 4.0), P=0.033] at admission. Moreover, patients with N₂O-induced SCD presented significantly lower mRS [2.0 (1.0, 2.0)] scores than those with N₂O-unrelated SCD [3.0 (3.0, 4.0), P < 0.001] at the last follow-up visit 3 months later.  Conclusion  These findings indicated that patients with N₂O-induced SCD have less severe neurological function deficit, an increased incidence of cord swelling and better prognosis.