顽固性呃逆、呕吐的症状对于鉴别急性炎性脱髓鞘疾病和预示复发的临床意义

Intractable hiccup and nausea in the acute inflammatory demyelination diseases:a clue to differential diagnosis and herald of acute exacerbation

目的探讨顽固性呃逆、呕吐(intractable hiccup and nausea,IHN)症状对于鉴别急性炎性脱髓鞘疾病和预示复发的意义。方法回顾分析1995年～2011年北京协和医院病房收治的临床诊断的24例存在IHN的急性炎性脱髓鞘疾病患者的临床和影像学资料,其中,分析IHN在不同疾病组中的分布,IHN与其他复发症状的关系、IHN相对应的延髓责任病灶的影像学特点、以及血清水通道蛋白4抗体检测结果。结果 24例急性炎性脱随鞘疾病患者包括视神经脊髓炎12例,多发性硬化5例,复发性长节段脊髓炎6例,急性播散性脑脊膜炎1例,共发生IHN35次,其中40%发生在急性脱髓鞘事件之前。视神经脊髓炎患者组、复发性长节段脊髓炎患者组、多发性硬化患者组各组间相互比较,发现复发性长节段脊髓炎组延髓病灶与高颈段脊髓相连的比例是5/9,较多发性硬化组1/9比例明显增高(P=0.039<0.05);视神经脊髓炎组患者血清水通道蛋白4阳性的比例是3/6,较多发性硬化组患者比例0/5明显增高(P=0.032<0.05)。各组患者在IHN与伴随症状的时间关系、伴随症状、出现延髓病灶的比例以及延髓病灶强化情况方面相比,无明显差异。结论 IHN可以作为鉴别急性炎性脱髓鞘疾病的参考,往往发生在其他症状之前,预示疾病复发。

Objective To investigate the symptom of the intractable hiccup and nausea（IHN） in acute inflammatory demyelination disease.Methods Retrospectively reviewed 24 patients with acute inflammatory demyelination disease in PUMC hospital from 1995 to 2011.The clinical profile,image characters of IHN and the result of serum AQ4 antibodies test in different disease groups were analyzed.Results There were a total of 35 episodes of IHN in these 24 patients,including 12 Neuromyelitis optica（NMO） patients,6 recurrent longitudinally extensive myelitis patients,5 multiple sclerosis patients and 1 acute dissemination encephalitis myelitis patient.The IHN frequently preceded（14/35,40%）.It was found that the ratio of patients with medulla oblongata lesions extending to the high cervical spinal cord was 5/9 in patients with recurrent longitudinally extensive myelitis,much higher than that in patients with MS（P=0.0390.05）.The ratio of patients with positive serum AQ4-antibody was 3/6 in patients with NMO patients,much higher than that in patients with MS（P=0.0320.05）.There was no difference in appearance pattern,preceding episode,ratio of positive medulla oblongata lesion and ratio of enhanced medulla oblongata lesion between different disease groups.Conclusion IHN might be a clue to differentiate the acute demyelination disease and herald the relapsing.