老年人多发性硬化的临床特点

Clinical features of multiple sclerosis in elderly patients

目的：探讨老年人多发性硬化（MS）的临床特点。方法患有 MS 的老年患者25例，对其病因、临床表现、辅助检查结果、治疗及预后结果等作回顾性分析。结果25例患者中，男12例、女13例，年龄60～75岁。既往曾患干燥综合征2例、类风湿关节炎1例。发病前有诱因者4例，亚急性起病21例，复发缓解型22例。神经系统症状为肢体无力14例、感觉障碍10例、大小便障碍8例、视力障碍8例、智能障碍7例。25例行血清抗水通道蛋白抗体-4检查均阴性。MRI 检查示大脑半球病变22例、脑干病变9例、颈髓病变7例、胸髓病变5例。23例诱发电位异常。急性期均予以糖皮质激素治疗，临床痊愈4例、好转16例。结论老年人 MS 以亚急性起病为主，多为复发缓解型；老年人 MS 常见症状是肢体无力、感觉障碍、视力障碍、二便障碍；脑脊液、MRI、神经电生理检查有助于本病的诊断；糖皮质激素在老年人 MS 治疗中发挥一定作用。

Objective To investigate the clinical features of multiple sclerosis （MS）in elderly patients.Methods We retrospectively analyzed the information of the etiology,clinical manifestation,assistant examination,treatment and prognosis of 25 elderly patients with MS.Results In 25 patients,12 cases were male,13 cases were female,and they were （65.8 ±5.5）years old.Two cases had a history of dry syndrome,and 1 case had a history of rheumatoid arthritis. Four cases were found because of inducement before the onset,and sub-acute onset was found in 21 cases,recurrent remis-sion in 22 cases.Symptoms of nervous system：limb weakness was found in 14 cases,sensory disturbance in 10 cases, sphincter dysfunction in 8 patients,visual disturbance in 8 cases,intelligent obstacle in 7 cases.Twenty-five cases of anti-aquaporin 4 antibody tests were all negative.MRI examination showed that cerebral hemisphere lesions were found in 22 ca-ses,brainstem in 9 patients,cervical spinal cord lesions in 7 cases,and thoracic lesions in 5 cases.Twenty-three cases of evoked potential were abnormal.They were all treated with corticosteroids in the acute phase,4 cases were cured,and 16 cases were improved.Conclusions Subacute onset is the main type in aged patients with MS,mostly relapse remission type.Limb weakness,sensory disturbance,visual disturbance,and sphincter dysfunction are common symptoms in aged MS.Cerebrospinal fluid,MRI and nerve electrophysiological examination help the diagnosis of MS.Glucocorticoids also play a certain role in the treatment of elderly MS.