脊髓亚急性联合变性19例分析及文献复习

Analysis of 19 cases of subacute combined degeneration of spinal cord and literature review

目的探讨脊髓亚急性联合变性的特点。方法回顾性分析近13年收治的脊髓亚急性联合变性患者19例,结合文献复习对其病因、发病机制、临床表现及治疗预后进行分析。结果男女患者比例1.71∶1,平均起病年龄55.37岁。营养障碍为主要病因(63.2%)。所有患者均有脊髓后索受累体征(100.0%)。11例合并贫血(57.9%),8例血清维生素B12降低(42.1%),2例内因子抗体阳性(10.5%)。影像学及电生理检查可以帮助诊断,但缺乏特异性。给予维生素B12治疗后均有不同程度好转。结论确诊亚急性联合变性主要通过既往病史、临床症状体征及相关实验室检查,早期给予维生素B12治疗有良好疗效。

Objective To explore the features of subacnte combined degeneration of spinal cord. Methods Nineteen patients with subacute combined degeneration of spinal cord were retrospectively analyzed. The literature review was undertaken to summarize the current advances in the etiological factor, pathogenesis, clinical manifestation and prognosis. Results The ratio of male to female cases was 1.71： 1, and average age of onset was 55.37. Dystrophia was the main etiological factor （63.2%）. All patients （ 100.0% ） showed posterior funiculus of spinal cord signs. Anemia was found in 11 of 19 cases （57.9%） The serum VitB12 level was low in 8 of 19 cases （42.1% ） and anti -intrinsic factor anti- body was positive in 2 patients （ 10.5% ）. Imageology and electrophysiology could help diagnosis, but lack of specificity. Treatment with VitB 12 obtained different degree of effectiveness in patients. Conclusion The diagnosis of subacute combined degeneration is mainly based on patient history, clinical manifestation and laboratory examination, treatment with VitB12 as early as possible may achieve favourable prognosis.