26例多发性硬化患者的临床与鉴别诊断

The Clinical Characteristics and Differential Diagnosis of 26 Patients with Multiple Sclerosis

目的 分析 2 6例临床确诊的多发性硬化 ( multiple sclerosis,MS)患者的临床资料。方法 回顾性总结临床确诊 MS患者的临床表现、实验室检查以及影像学表现。结果 2 6例 MS患者最常见的临床症状为肢体无力和感觉异常 ,其次为肌肉痉挛性疼痛、视力障碍、尿便异常、共济失调 ,个别患者可有周围神经改变。实验室检查示 :脑脊液蛋白水平和 Ig G量增高最常见。磁共振 ( MRI)异常率高达 90 .9%。结论 MS是一种临床表现复杂、累及中枢神经系统白质多部位、病程表现多时相的自身免疫性疾病。但临床有周围神经症状及 MRI发现皮层病灶也并非是排除 MS的绝对标准。在诊断 MS时 ,尤其对于单病灶或多病灶、单时相病程患者应从临床和影像学方面注意与脑梗死、脊髓疾病相鉴别。

Objective The clinical data of 26 patients with MS were reviewed. Methods According to the new diagnostic criteria for MS, 26 patients with clinical verified multiple sclerosis were investigated, whose clinical manifestation, laboratory examinations and imaging results were analyzed.Results Male and female ratio was 11∶15. Average age of onset was (36.85±10.05) years. The most common symptoms were weakness(96%) and dysesthesia(84.6%) ,which characterised as transversal injury or hemilateral symptoms, secondly, were muscle spasm and pain (57.5%), vision dysfunction (34.6%),incontinence(42.3%), and ataxia(34.6%). The rare symptoms were peripheral neurological changes. Laboratory examinations: Protein and IgG levels in CSF were markedly high in 88% , and 80% patients respectively and increasing IgM, IgA, PAB levels in blood were respectively 73.3%, 53.3% ,61.5% . MRI and VEP abnormal ratio were 90.9% and 60% respectively. These changes were contributed to diagnose MS.Conclusions There are a variety of clinical symptoms in patients with MS, which mainly affected the white matter of central neurological system and showed multiple focus and multiple-phase course. The diagnosis of MS can't be excluded when the patients present peripheral neuropathy or whose MRI shows non-white matter lesions. Regarding clinical and MRI showings, it should be differentiated with CVD and myelopathy.