急性播散性脑脊髓炎临床分析

Clinical analysis of acute disseminated encephalomyelitis

目的探讨急性播散性脑脊髓炎临床和诊治特点分析,为临床治疗提供依据。方法回顾性分析2009年6月-2013年6月医院治疗的66例急性播散性脑脊髓炎患者临床资料,根据治疗方案的不同分为甲泼尼龙治疗组39例和地塞米松治疗组27例;观察两组患者治疗效果,同时记录MRI检查情况及临床表现;采用SAS 14.0软件进行统计分析。结果急性播散性脑脊髓炎患者临床症状主要以意识障碍、头痛头晕、恶心呕吐、运动障碍为主;经头颅MRI检测异常的患者中病变发生部位集中在大脑皮层下、侧脑室、脑干和小脑为主;甲泼尼龙治疗组总有效率为97.44%,地塞米松治疗组为74.07%,组间比较,差异有统计学意义(P<0.05)。结论急性播散性脑脊髓炎临床起病急骤,症状复杂多样,采用甲泼尼龙联合丙种球蛋白治疗效果可靠,给予及时治疗预后良好。

OBJECTIVE To explore the clinical characteristics of acute disseminated encephalomyelitis so as to provide guidance for the clinical treatment. METHODS The clinical data of 66 patients with acute disseminated encephalomyelitis who were treated in the hospital from Jun 2009 to Jun 2013 were retrospectively analyzed, then the patients were divided into the methylprednisolone group with 39 cases and the dexamethasone group with 27 cases according to the treatment programs, the therapeutic effect was observed and compared the two groups, the MRI examination result and the clinical manifestations were recorded, and the statistical analysis was performed with the use of SAS 14. 0 software. RESULTS The clinical symptoms of the patients with acute disseminated encephalomyelitis mainly included the disturbance of consciousness, headache, dizziness, nausea and vomiting, and movement disorders. The result of the cranial MRI examination showed that the cerebral cortex, lateral ventricle, brain stem, and cerebellum were the major lesion sites. The total effective rate of treatment was 97.44 % in the methylprednisolone group, 74.07% in the dexamethasone group, showing statistically significant difference between the tow groups （P〈0.05）. CONCLUSION The onset of acute disseminated encephalomyelitis is rapid, and the clinical symptoms are diversified; the methylprednisolone combined with gamma globulin can achieve reliable therapeutic effect and obtain good prognosis if it is treated in a timely manner.