31例脊髓亚急性联合变性临床分析

Clinical Analysis of 31 Patients with Subacute Combined Degeneration of the Spinal Cord

目的总结脊髓亚急性联合变性(SCD)的病因、临床特征、诊断及治疗。方法对31例临床确诊SCD患者的临床资料进行回顾性分析。结果64.5%(19/31)的SCD患者有贫血,41.9%(13/31)患者血清VitB12水平降低,脊髓MRI检查发现20.0%(4/20)患者可见脊髓后索存在特异性异常信号,84.6%(22/26)患者肌电图有异常改变,体感诱发电位(SEP)检查阳性率100%,经VitB12治疗90.3%(28/31)患者临床症状均有不同程度好转。结论SCD多由VitB12缺乏引起,试验性VitB12治疗有效,对明确诊断有重要意义;肌电图及SEP等检查可辅助诊断。

Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of subacute combined degeneration in the spinal cord （SCD）. Methods Sufficient data were collected and analyzed retrospectively in 31 patients with clinically confirmed SCD. Results Anemia was found in 19 of 31 cases（64.5%）. The serum VitB12 level was lower than before on-set of the disease in 13 of 31 cases （41.9%）. Among 20 patients, MRI exhibited special abnormal signal intensity in dorsal columns of the spinal cord of 4 patients （20.0%）. 22 of 26 patients（84.6%） showed abnormal changes in electromyography. The abnormal rate of somatosensory evoked potential was 100% in these patient. 28 of 31 patients （90.3%） got effectiveness after treatment with VitB12. Conclusions SCD was mainly caused by the deficiency of VitB12. Clinical improvement after VitB12 treatment played an important role in the diagnosis of SCD. Electromyography and cerebral evoked potential were also useful for the diagnosis.