脊髓亚急性联合变性临床分析

Study on the Vitamin B12 deficiency in 32 patients with subacute combined degeneration

目的 探讨维生素B12缺乏导致的脊髓亚急性联合变性的临床特点及转归.方法 回顾性分析32例脊髓亚急性联合变性患者的临床资料.测定血清维生素B12及叶酸浓度,肌电图检查28例,脊髓MRI检查16例.结果 15例血清维生素B12水平低于正常,17例正常;肌电图及神经传导速度测定异常26例;脊髓MRI检查4例患者出现脊髓后索长T2高信号影;神经系统症状主要表现为肢体感觉异常,痉挛性瘫痪、深感觉减退、共济失调等.经3～6个月治疗,症状缓解者27例,部分改善者5例;排尿排便功能改善4例;舌炎改善5例;胸腹部束带感明显改善3例,无明显改善1例;贫血改善8例.5例病程在1年以上,维生素B12治疗后肢体功能无明显改善而成残疾状.结论 维生素B12缺乏是引起脊髓亚急性联合变性的重要原因,但血清维生素B12水平并不能准确反应机体是否真正缺乏维生素B12,维生京B12水平正常者应结合临床症状及体征进行综合考虑,以免误诊.

Objective To explore the clinical nenrological manifestation of subacute combined degeneration （SCD） in 32 cases. Methods The serum levels of Vitamin B12（Vit B12） and folic acid were measured,the nerve conduction （NCV） and magnetic resonance imaging（MRI） in spinal cord were examined respectively. The neurological function was investigated in all cases. Results The serum level of Vit B12 decreased in 15 cases but showed normal level in 17 cases. NCV were reduced. The high signal intensity in dorsal columns of spinal cord in MRI was found in 4 cases. After 3 to 6 months of treatment,27 patients got their symptom relieved,and 5 got partly improved. Four cases got improvement on urination and defecation;5 cases on glossitis and 8 cases on anemia. Five cases had not obvious improvement on limb mobility due to a course longer than one year. Conclusion Vit B12 deficiency is an important pathogenic factor in SCD and SCD should be diagnosed with clinical feature and neurological manifestation. Early diagnosis and treatment remain important in preventing permanent damage.