脊髓亚急性联合变性24例临床分析

The clinical analysis of 24 patients with subacute combined degeneration of the spinal cord

目的探讨脊髓亚急性联合变性(subacute combined with degeneration of the spinal cord,SCD)的临床特征、实验室检查、MRI表现特点。方法对24例SCD患者的临床资料进行回顾性分析。结果本组患者男16例、女8例,平均年龄(56.29±13.05)岁。(1)临床表现:同时有脊髓后索、侧索及周围神经的表现者占41.67%(10/24),有脊髓后索及侧索表现者占29.17%(7/24),有脊髓侧索及周围神经表现者占12.50%(3/24),有脊髓后索及周围神经表现者占12.50%(3/24),只有脊髓后索表现者占4.17%(1/24)。既往有胃部疾病史者占41.67%(10/24)。(2)实验室检查:血红蛋白(hemoglobin,HGB)降低者占20.83%(5/20),平均红细胞体积(MCV)升高者占41.67%(10/22),平均红细胞血红蛋白量(MCH)升高者占40.91%(9/22),平均红细胞血红蛋白浓度(MCHC)升高者占9.11%(2/22)。内因子抗体阳性5例(5/6)。(3)影像学检查:可见髓内异常信号者占21.05%(4/19),其中病灶位于胸髓1例,颈髓3例,病变均在脊髓后索及侧索。头颅MRI检查显示50%(8/16)有脑白质脱髓鞘改变。结论 SCD患者可以出现脊髓后索、侧索及周围神经的合并受累或者单独受累。维生素B12正常并不能排除SCD诊断,MCV指标的升高可以作为维生素B12缺乏的诊断指标之一,内因子抗体检测有助于查找病因。发病半年内脊髓MRI显示病灶阳性率更高,约半数患者头颅MRI可出现脑白质病变。

Objective To investigate the clinical manifestations, laboratory tests, MRI features of subacute combined degeneration of the spinal cord （SCD）. Methods The clinical data of 24 SCD patients were analyzed retrospectively. Results This group of patients comprised of 16 males and 8 females, and aged 34 to 79 years. Ten of them had posterior cord, lateral funiculus and peripheral nerve lesions; 7 of them only existed posterior cord, lateral funiculus lesions; 1 of them only had posterior cord lesions; 3 of them had lateral funiculus and peripheral nerve lesions; 3 of them had posterior cord and peripheral nerve lesion. Gastric disease （8/24）, anemia （5/20）, elevated mean corpuscular volume （MCV） （10/22）, elevated mean corpuscular hemoglobin （MCH） （9/22）, elevated mean corpuscular hemoglobin concentration （MCHC） （2/22）, intrinsic factor antibodies positive （5/6） were found in these patients. MRI （cervical and thoracic regions were performed in 19 cases, 4 of them have intramedullary abnormal signal, 1 ease in thoracic cord, and 3 cases in cervical cord. Abnormal signal changes were found within posterior columns and lateral columns of spinal cord. MRI of head were performed in 16 cases, half of them had cerebral white matter demyelination. Conclusions Combined or individually involvement of posterior column, lateral columns of spinal cord and peripheral nerve can occur in SCD patients. Normal vitamin B12 level can＇ t exclude the diagnosis, elevated MCV may be a manifestation of vitamin B12 deficiency and intrinsic factor antibody test can help confirm the etiology. Within six months of onset, spinal MRI has a high positive rate, most patients have cranial MRI white matter lesions.