大剂量甲钴铵治疗亚急性联合变性的临床、影像及电生理分析

Clinical,Magnetic Resonance Imaging and Electrophysiological Analysis with High-dose Mecobalamine Therapy for Subacute Combined Degeneration

目的:观察亚急性联合变性(SCD)患者的临床特点、影像学(MRI)、电生理表现及甲钴铵治疗前后的变化,评价其诊断价值和疗效。方法:选取15例SCD患者,检测血常规和血清维生素B12、叶酸浓度,进行周围神经传导速度、体感诱发电位、视觉诱发电位、听觉诱发电位及脊髓MRI检查,观察治疗前后血红蛋白、血清维生素B12浓度、MRI及电生理的变化,并进行神经功能评定。结果:经甲钴铵治疗后患者临床症状明显改善,脊髓MRI显示的颈胸髓内后索、侧索长条状等T1长T2异常信号,治疗后多数病灶缩小或消失,电生理改变亦明显好转。结论:MRI诊断SCD准确度高;电生理检查敏感度高,且可发现亚临床病灶。两者结合可有助于SCD的早期明确诊断。大剂量甲钴铵静脉滴注可迅速提高血清维生素B12浓度,吸收利用度好,能有效改善SCD患者的神经功能。

Aim： To observe clinical, magnetic resonance imaging （MRI）, electrophysiological features in patients with subacute combined degeneration （SCD） and their changes before and after mecobalamine therapy, and to evaluate their diagnostic value and efficacy. Methods： 15 cases with SCD were selected and received a series of examinations, including blood routine test, serum vitamin B12 and folic acid concentrations, peripheral nerve conduction velocity （NCV）, somatosensory evoked potentials （SEP）, visual evoked potentials （VEP）, brainstem auditory evoked potentials （BAEP） and spinal cord MRI examinations. The hemoglobin （Hb）, serum vitamin B12 concentration, MRI and electrophysiological changes and neurological assessment were studied before and after treatment. Results： After mecobalamine treatment, all patients＇ clinical symptoms were improved. The spinal cord MRI showed long-tape abnormal signals in posterior and lateral columns of the cervical and thoracic cord, iso-intense on T1 and hyper-intense on T2 signal. Most lesions constricted or disappeared, and electrophysiological changes are appeared a marked improvement after treatment. Conclusion： MRI diagnosis of SCD has high accuracy, electrophysiological examination has high sensitivity and can find the sub-clinical lesions. A combination of both MRI and electrophysiological examination could contribute to early diagnosis of SCD. High-dose intravenous drip mecobalamine can quickly raise the serum vitamin B12 concentrations, has good degree of absorption and utilization, and help improve neurological functions in the patients with SCD.