脊髓病变特点对急性脊髓炎预后的影响

The prognostic value of features of spinal cord lesions in acute transverse myelitis

目的 探讨急性脊髓炎（ATM）患者脊髓病变特点对患者预后的影响.方法 对59例首发的急性脊髓炎患者的临床和影像资料进行回顾性分析,并对患者进行随访.根据脊髓病变长度和症状体征是否对称及神经功能受损程度分为长脊髓节段和短脊髓节段组以及急性完全性脊髓炎（ACTM）和急性部分性脊髓炎（APTM）组,分别比较组间患者的扩展功能障碍量表评分（EDSS）以及随访期间年复发率.结果 59例患者平均随访33.02个月（5～180个月）.其中长脊髓节段组44例,短脊髓节段组15例,2组患者病情达高峰时EDSS分别为（6.34±2.00）分和（5.97±1.87）分（P＞0.05）;病情稳定后EDSS分别为（6.02±2.98）分和（4.64±3.35）分（P＞0.05）.2组随访期间年复发率分别为0.32%和0.43%（P＞0.05）.59例患者中APTM组39例,ACTM组20例,病情达高峰时平均EDSS评分分别为（5.03±1.69）分和（7.60±1.25）分（P〈0.001）;病情稳定时EDSS评分分别为（4.50±2.89）分和（7.12±2.17）分（P〈0.001）.随访期间年复发率分别为0.33%和0.16%（P＜0.05）.结论 急性脊髓炎患者大部分为单相病程,单纯脊髓病变长度不能用于评估患者病情严重程度及病后恢复情况,不能作为急性脊髓炎患者预后的指标.对急性脊髓炎患者进行APTM/ACTM分类有明确的预后价值.

Objective To evaluate the prognostic value of the features of spinal cord lesions in patients with acute transverse myelitis （ATM）. Methods The clinical and neuroimaging data of 59 patients with first-ever ATM were retrospectively reviewed. The patients were divided into the long spinal cord segments group and the short spinal cord segments group according to the length of the lesions involved vertebral segments, and acute complete transverse myelitis（ACTM） group and acute partial transverse myelitis（APTM） group according to the severity of disease and the symptoms is symmetrical or not. The Kurtzke＇s Expanded Disability Status Scale （EDSS） at the peak of illness and after treatment and the risk of recurrent were compared between groups. Results The mean follow-up time was 33 months （5 to 180 months）. The mean EDSS scores of patients in the long spinal cord segments group（44 patients） and the short spinal cord segments group（15 patients） were 6.34 ±2.00 and 5.97±1.87 respectively during the peak of the illness（P〉0.05）, and 6. 02±2.98 and 4. 64±3.35 after therapy respectively（P〉0.05）. The annual relapse rates were 0.32% and 0.43% respectively during the follow-up time（P〉0.05）. The mean EDSS score of patients in APTM and ACTM groups during the peak of the illness were 5.03±1.69 and 7. 60±1.25 （P〈0. 001）, 4.50±2.89 and 7.12±2.17 after therapy respectively（P〈0. 001）. The annual relapse rates were 0. 33% and 0.16% during the follow up time（P〈0.05）. Conclusion ATM remained a monophasic event in most of patients. The length of the involved spinal cord segments can not be regarded as prognostic factor separately. It is very important to distinguish APTM and ACTM in clinic practice for evaluating the prognosis of ATM.