特发性急性脊髓炎与多发性硬化及视神经脊髓炎转归的关系

The course and prognosis of idiopathic acute transverse myelitis：a retrospective cohort study

目的 探讨特发性急性横贯性脊髓炎（IATM）患者的临床特征及转归预后.方法 对78例临床诊断为IATM的患者病程各阶段EDSS评分、脑脊液、脊髓MRI检查及预后进行分析.结果 对患者平均随访4.7年.单相组病情高峰及恢复阶段病情更重,但长期随访显示两组患者预后方面差异无统计学意义（P＞0.05）,均达到轻度功能受损.初发表现为部分性急性脊髓炎（APTM）的患者更易出现复发.脊髓累计≥3个节段较多见于单相组.末次随访显示18例转化为视神经脊髓炎（NMO）,未发现转化为多发性硬化（MS）的病例.结论 APTM可能更易复发,长段脊髓受累可能是复发的保护性因素.脊髓单相组与复发组预后均尚可,IATM易转化为NMO.

Objective To investigate the demographic,clinical and prognosis of idiopathic acute transverse myelitis （IATM）. Methods Subjects with monophasic or recurrent IATM （n = 39 ） were included. Motor, sensory and autonomic dysfunction was staged according to EDSS scores. Cerebrospinal fluid（CSF） data and the number of levels affected in the spinal magnetic resonance imaging（MRI） were also recorded. Results Mean follow-up time was 4.7 years. Motor and autonomic dysfunctions were more severe in monophasic group, but both group were associated with a good outcome in the long-term. The higher frequency of acute partial transverse myelitis （APTM） in the recurrent group, while the higher fre- quency of longitudinally extensive transverse myelitis in monophasic group. Nine patients converted to neu- romyelitis optica（NMO）. We found no cases converted to multiple sclerosis（MS）. Conclusion It seems that APTM associated with recurrence, while longitudinally extensive transverse myelitis indicated a monophasic course. The prognosis were good in most IATM patients. IATM yielded high conversion rate to NMO.