多发性硬化合并葡萄膜炎二例报告

Multiple sclerosis combined with uveitis:a report of two cases

目的 探讨合并葡萄膜炎的多发性硬化 (MS)的临床及可能的病理机制。方法 对 2例合并葡萄膜炎的MS进行临床、电生理、头颅MRI和寡克隆带检查及结合文献分析可能的病理机制。结果 例 1男性 ,5 6岁 ,主要表现为肢体麻木 1个月 ,突发双眼视力下降 2 0d。视觉诱发电位示双眼P 10 0潜伏期延长 ,头颅MRI示双额顶白质内T2 WI多发性高信号 ,寡克隆带阳性。例 2女性 ,35岁 ,主要表现为反复发作的双眼视力下降伴双下肢麻木无力 12个月 ,视觉诱发电位P 10 0及脑干听觉诱发电位I～V潜伏期延长 ,头颅MRI示额顶叶白质内多发性类圆形T2 WI高信号 ,寡克隆带阳性。结合文献复习合并葡萄膜炎的MS临床表现大多轻微 ,病因不明 ,可能不是自身抗原髓鞘碱性蛋白 ,而是星形胶质细胞来源的S 10 0 β引起的。 结论 合并葡萄膜炎的MS临床表现大多轻微 ,其发病机制不详 ,据认为与髓鞘碱性蛋白抗原引起的MS不一样 ,可能是星形胶质细胞来源的S 10 0 β引起。

Objective To investigate the clinical manifestations and possible mechanism of the multiple sclerosis (MS) combined with uveitis Methods Two cases of MS combined with uveitis were clinically observed by electro physiological, brain MRI and oligoclonic band (OB) examinations,the cases were analyzed and subjected to assessment Results Case1, a 56-year-old man had symptoms of one month′s numbness and twenty-day sudden decrease of visual acuity Viusal evoked potential (VEP)showed a postponed latent period of bilateral P100 waves Brain MRI showed multifocal T 2 Wight Image high signs in subcortical white matter of frontal and parietal lobes OB was postive Case 2: a 35-year-old woman, had recurrence of decrease of visual acuity of bilateral both eyes for 12 months and bilateral lower-limbs numbness Latent period of VEP P100 waves and BAEP I-V waves were postponed Brain MRI showed multifocal round-like T 2 Wight Image high signs in white matter of frontal and parietal lobes OB was postive Referring to the essay reported ,MS combined with uveitis was moetly moderate in manifestations Their causes were uncertain It is suggested that MS is not due to auto-antigen but due to S100-β protein derived from star-like cells Conclusion MS combined with uveitis ,unlike other one ,was clinically moderate and the pathological mechanism is unclear It is suggested that autoantigen such as S100-β protein derived from star-like cell results in MS and uveitis, not in MBP