急性播散性脑脊髓炎36例临床特点分析

A systematic review of 36 patients diagnosed with acute disseminated encephalomyelitis

目的阐明急性播散性脑脊髓炎(ADEM)的临床特点及诊治方法。方法分析宣武医院2003年至2010年36例ADEM住院患者的一般临床资料、临床表现、辅助检查及治疗与预后转归情况。结果本文病例多见于儿童和青壮年,急性起病,3例复发。其常见诱因为急性上呼吸道感染、疫苗接种、麻疹、风疹、水痘、流行性腮腺炎、猩红热等共计29例,原因不明7例。实验室检查中脑脊液可出现免疫球蛋白增高,磁共振成像检查提示受累部位包括脊髓、小脑、大脑白质及脑干等,其它辅助检查如电生理和免疫学检查等可协助诊断,应用糖皮质激素治疗效果确切。结论结合临床特点、神经电生理、脑脊液免疫学及影像学检查等,临床可以作出准确诊断,及时恰当的治疗对预后极为重要。

Objective To further clarify the clinical features,diagnosis and treatment of the acute disseminated encephalomyelitis（ADEM）.Methods This study were to perform a prospective clinical（2003-2010） on ADEM in patients consecutively referred to Xuanwu Hospital in Beijing,China,and undertake a systematic review of general clinical data,clinical manifestations,laboratory examinations and treatment and prognosis of outcome of 36 patients with ADEM.Results The 36 patients had the following characteristics： children and young adults were predomidantly developed with ADEM with an acute onsets,and 3 cases relapse in this group of patients.The common causes included acute upper respiratory tract infection,vaccination,measles,rubella,chickenpox,mumps,scarlet fever,etc.The immunoglobin in cerebrospinal fluid（CSF） increased.Imaging examinations,especially magnetic resonance imaging（MRI） examinations showed spinal cord,cerebellum,cerebral medullary substance and brain stem were often affected.Other laboratory examinations such as electrophysiological,immunological tests were helpful for diagnosis.The administration of glucocorticoid was effective for treatment of ADEM.Conclusion Here we show that clinical features,functions synergistically with neuroelectrophysiology,CSF immunology and imaging investigations greatly aid clinical definite diagnosis,and it is im portant to treat the patients in time and properly for the better prognosis.