多发性硬化118例临床分析

The Clinical Analysis of 118 Multiple Sclerosis Cases

目的探讨多发性硬化(MS)的临床特征及MRI、视觉诱发电位(VEP)、脑干听觉诱发电位(BAEP)、脑脊液(CSF)检查在诊断中的价值。方法从流行病学、首发症状、起病形式、病程、累积部位、各项辅助检查情况等方面对作者医院1998—2004年收住的118例MS患者进行回顾性分析。结果118例MS患者中,临床确诊68例,实验室支持确诊21例,临床可能29例;男、女比为1.46∶1;平均首发年龄:男(31.1±13.5)岁,女(34.9±10.5)岁;起病形式:急性37.0%,亚急性40.0%,慢性23.0%;病程:复发-缓解型占67.0%;首发症状:肢体无力58例,肢体麻木34例,视力障碍29例。累及部位:视神经80例,脊髓72例,脑干61例,大脑半球50例,小脑26例。MRI:行MRI检查82例,阳性67例,其中累及脊髓32例,脑室旁34例(占MRI检查阳性者的50.7%)。VEP:异常但无症状体征者占47.0%;BAEP:异常但无症状体征者占81.5%。CSF:24 h鞘内合成率阳性占81.6%,寡克隆区带阳性占23.0%。结论MS多无明显诱因,多以急性或亚急性起病,复发率高,首发症状以肢体无力多见,脊髓、视神经易受累,MRI检查阳性者中半数左右大脑白质有异常信号,VEP、BAEP检查可发现许多视神经及脑干亚临床病灶,CSF 24 h鞘内合成率阳性者较多,可提示病变的炎性本质。

Objective To study clinical features of multiple sclerosis （MS） and to evaluate the value of MRI, VEP, BAEP, and CSF on the diagnosis of MS. Methods The clinical data of 118 MS patients admitted to the department of neurology. The First Affiliated Hospital of Zhengzhou University was collected. The epidemiological data, early symptom and sign, clinical progressive mode, course, and the localization of lesion were analyzed retrospectively. Results The clinical classification of the 118 cases was clinically definite MS in 68 cases, laboratory supported MS in 21, and clinically possible MS in 29. The ratio of male to female was 1.46 ： 1. The average onset age was 31.1 for male and 34.9 for female. The clinical onset was acute in 37%, subacute in 40%, and chronic in 23%. Six-seven percent of patients with MS were relapsing and remitting type. The initiating symptom was weakness in 58 cases, numbness in 34, visual disturbance in 29. The localization of lesion was optic nerve in 80 cases, spinal cord in 72, brain stem in 61, cerebral in 50, cerebellum in 26. The MRI data was available in 84 patients, abnormal signals were found in 67 cases, spinal cord abnormal signals in 32 cases, paraventricular abnormal signals in 34 cases. Forty-seven percent patients with abnormal VEP and 81.5% patients with abnormal BAEP were asymptomatic. The 24 h IgG synthetic rate was determined in 49 patients, of these 81.6% were abnormal, OB was determined in 53 patients, but the positive rate was only 23%. Conclusions Precipitating factors are not often detected in our serious. Acute or subaeute onset is often. Relapsing rate is high. The weakness was the initiating symptom in most MS patients. Optic nerve and spinal cord are frequently involved. The cerebral white matter lesions may be found in around half of MS patients who showed abnormal MRI signals. Some subclinical lesions in the CNS may be discovered by VEP or BAEP. 24h IgG synthetic rate suggests the nature of abnormal humoral immunity.