特应性脊髓炎临床和影像学特点分析

An analysis of clinical and imaging characteristics of atopic myelitis

目的 分析中国人特应性脊髓炎（AM）的临床和影像学特点.方法 对3例AM患者的临床特点、脊髓MRI以及治疗效果进行回顾性分析.结果 3例患者均为男性,发病年龄分别为25、47及49岁,均为亚急性起病.2例有花粉过敏及多种药物过敏史,1例有过敏性鼻炎;3例均伴血清总IgE水平升高及尘螨特异性抗体（＋）.3例均以肢体远端感觉异常为主要临床特点,视力、肌力和排尿排便功能均相对保留,其中2例患者伴Lhermitte征（＋）.3例患者脑脊液寡克隆区带（-）,血清水通道蛋白4抗体（-）.脊髓MRI示例1第2～3胸髓节段后索异常信号伴强化;例2第2/3颈髓节段后索异常信号,略肿胀;例3第3～5颈髓节段后索为主异常信号,伴肿胀及异常强化.1例应用营养神经药物、2例经大剂量糖皮质激素冲击治疗并缓慢减量,3例均获得不同程度缓解.结论 伴高IgE血症和尘螨过敏原特异性抗体阳性的亚急性脊髓炎临床以肢体远端感觉异常为主,运动症状相对较轻;影像学上以颈髓后索受累为主,可伴局部肿胀和异常强化;糖皮质激素治疗至少维持3～6个月.

Objective To study the clinical and imaging characteristics of Chinese atopic myelitis （AM） patients.Methods Three diagnosed AM patients were retrospectively analyzed for the clinical data,serum IgE level,antigen specific IgE,cerebrospinal fluid,spinal MRI and therapeutic efficacy profiles.Results All the three patients were male and presented as subacute AM with the onset at 25,47 and 49 years old respectively.Two patients were allergic to pollen and other drugs,while another patient suffered from allergic rhinitis.Elevated serum total IgE and mite antigen specific IgE were found in all cases.Paraesthesia in limb extremities and positive Lhermitte sign were the main clinical features,while no optic,motor,urinary and defecation disturbance were found.Oligoclonal banding of cerebrospinal fluid and serum aquaporin 4 （AQP4） antibody were both negative in all cases.Spinal MRI showed lesions were hypointense on T1 and hyperintense on T2 at the posterior column of T2-3 segment with abnormal enhancement in case 1,hypointense on T1 and hyperintense on T2 at C2/3 segment with mild swelling in case 2 and hypointense on T1 and hyperintense on T2 at C3-5 segments with swelling and abnormal enhancement in case 3.Vitamin B were used in one patient,while the other two patients improved after the treatment with high-dose corticosteroids.Conclusions Subacute myelitis predominantly presents as paraesthesia in limb extremities with elevated serum total IgE and mite antigen specific IgE,while severe motor disorders are rare.Swelling and abnormal enhancement lesions at the posterior column of cervical cord are the common imaging features.Treatment with corticosteroids is recommended to be sustained for 3-6 months.