不同类型多发性硬化的临床及影像学特点

Clinical and imaging features in different types of multiple sclerosis

目的探讨不同类型多发性硬化(MS)的临床及影像学特点。方法对57例晚发型MS(LOMS)患者和57例早发型MS(YOMS)患者的临床及影像学的资料进行分析和比较。结果 LOMS组首次发病的运动障碍及病程中括约肌功能障碍的出现率明显高于YOMS组(P<0.05～0.01),而首次发病的感觉障碍、视觉障碍,查体发现的运动、视觉和构音障碍、视神经炎及病程中新发运动障碍出现率明显低于YOMS组(P<0.05～0.01)。LOMS组78.9%多为原发进展型,而YOMS组70.2%为复发缓解型,两组间的差异有统计学意义(均P<0.001)。LOMS组脑脊液细胞增高的比率、脑脊液细胞数平均值(17.5%,5×106/L)与YOMS组(35.1%,14×106/L)比较差异具有统计学意义(均P<0.005)。MRI显示,YOMS组小脑病灶出现率(60.0%)明显高于LOMS组(25.0%),而LOMS组脊髓异常的比率(47.4%)明显高于YOMS组(24.6%)(P<0.05～0.01)。急性发作期大剂量糖皮质激素治疗LOMS组显效20例(35.1%),YOMS组为41例(71.9%),两组的差异具有统计学意义(P<0.05)。结论 LOMS以运动障碍、括约肌功能障碍较多,而YOMS则以感觉、视力和构音障碍及视神经炎更常见。MRI显示YOMS患者病灶在小脑的比率高,而LOMS患者病灶在脊髓的比率多于YOMS。

Objective To explore the clinical and imaging features in different types of multiple sclerosis （MS）. Methods The clinical date of 57 late-onset multiple sclerosis （LOMS） patients and 57 young-onset MS （YOMS） patients were analyzed and compared. Results The rates of motor dysfunction of first onset and sphincter dysfunction of new emergence in course in LOMS group were significantly higher than those in LOMS group （ P 〈 0. 05 - 0.01）. The rates of sensory and visual disturbance of first onset, motor disturbance and visual disturbance and dysarthria and optic neuritis by examnination, motor disturbance of new emergence in course in LOMS group were significantly lower than those in LOMS group （P 〈 0.05 -0.01 ）. The primary progressive in LOMS group was 78. 9%, and the relapsingremitting course in YOMS group was 70.2%, and the difference between the two groups had statistical significance（ all P 〈 0. 001 ）. The differences of the rate of elevated CSF cell count and the mean value of CSF cell count between LOMS group （17.5% ,5 ×10^6/L） and YOMS group（35. 1%, 14 ×10^6/L） were significant （all P 〈 0. 005 ）. MRI showed that the rate of lesions at ＇cerebella in YOMS group （ 60.0% ） were significantly higher than that in LOMS group（25.0% ）, but the rate of spinal lesion in LOMS group （47.4%） was significantly higher than that in YOMS group （24.6%） （P 〈 0. 05 -0. 01 ）. The obvious efficacy in LOMS group was 20 cases （35.1%）, and 41 cases （71.9%） in YOMS group at acute stage treated with large doses of intravenous glucocorticoid. The difference had statistical significance （P 〈 0. 05 ）. Conclusions The common clinical features of LOMS are dyskinesia and sphincter dysfunction. The common clinical features of YOMS are sensation disorders, impaired vision, dysarthria and optic neuritis. MRI showed that the rate of cerebellum lesions in YOMS patient is more than LOMS, and rate of spinal lessionsin LOMS group is more than YOMS.