脊髓亚急性联合变性17例临床分析及随访

Subacute Combined Degeneration of the Spinal Cord:A clinical analysis and followed-up of 17 cases

目的探讨脊髓亚急性联合变性(SCD)患者的临床特点、MRI表现及转归。方法回顾性分析17例SCD患者的临床特点、辅助检查结果、治疗及转归。结果(1)本组患者的相关病因:既往有贫血8例,慢性胃炎6例,胆源性胰腺炎、胃切除术后、克隆病、小肠功能紊乱各1例,有严格素食习惯者4例。(2)症状:双下肢疲乏无力、步态不稳13例,伴双下肢踩棉花样感8例,四肢末端有手套、袜套样感觉减退5例。体征:双下肢肌力下降、双下肢腱反射亢进者13例,腱反射减弱或消失4例;病理征阳性9例;跟-膝-胫试验阳性7例;闭目难立征阳性6例;霍夫曼征阳性3例。(3)15例患者血清维生素B12水平降低;12例患者行脊柱MRI检查,8例有异常信号,呈条带状等T1和长T2异常信号,4例行增强扫描无强化。(4)15例患者给予维生素B12500μg肌肉注射,1次/d,治疗4～6周后减量为2～4次/周,总疗程为3～6个月;2例患者行经骶骨裂孔穿刺注入维生素B122mg、维生素B1200mg、维生素B6100mg、复方丹参6ml、0.9%氯化钠溶液15ml、2%盐酸利多卡因3ml,每4d注射1次,5次为1疗程。4例患者临床症状消失,8例症状明显改善,3例症状轻度改善,2例效果不明显。结论诊断SCD要结合病史、临床表现及相关实验室检查结果,注意与多发性硬化、急性脊髓炎等鉴别。对患者补充维生素B12后症状可改善。

Objective To investigate clinical characteristics, features in MRI and clinical outcome of subacute combined degeneration （SCD） of the spinal cord. Methods The data of 17 SCD patients were retrospectively analyzed on the clinical characteristics, results of accessory examinations, treatment and conversion. Results The relative conditions of the patients included anemia （8 cases）, chronic gastritis （6 cases）, biliary pancreatitis, postgastrectomy, Crohn disease dysfunction of small intestine （ 1 case for each）, and strict vegetarian （4 cases）. The symptoms were lassitude of lower limbs with reeling gait （13 cases）, a feeling of lower limbs just like treading cotton （8 cases）, glove or sock like hypoesthesia of lower limbs （5 cases）. The signs were myedynamic decrease and tendon hyperreflexia of lower limbs （ 13 cases）, tendon hypo - reflexia or areflexia （4 cases）, positive pathological sing （9 cases）, positive heel -knee -tibia test （7 cases）, positive Romberg＇s sign （6 cases）, positive Hoffmann＇s sign （3 cases）. There were 15 patients whose serum vitamin Bl2 level was decreased. Among 12 patients receiving spine MRI there were 8 with linear T1 abnormal signal and long T2 abnormal signal, and 4 with no reinforcement in enhancement scanning. There were 15 patients who received vitamin B12 intramuscular injection, 12 500μg, once a day, 4 - 6 weeks later 2 - 4 times a week, the total course was 3 - 6 months. There were 4 patients whose clinical symptoms dis- appeared, 8 whose symptoms were evidently improved, 3 slightly improved, and 2 with obvious effect. There were 4 patients who were given by sacral hiatus puncture injection of 2 mg vitamin B12, 1200 rag vitamin B1, 6100 mg vitamin 136, in 6 mL compound Salvia, 15 mL sodium chloride and 3 mL lidocaine hydrochloride, once every 4 days, 5 times was a course. The resuits were good. Conclusion In diagnosis of SCD, the patients＇ history, clinic findings and the results of relative laboratory examinations should be considered, and the differentiation from multiple sclerosis and acute myelitis be stressed. The patients＇ symptoms may be improved by supply of B12.