合并肺结核的长节段脊髓炎2例报告

Longitudinally extensive transverse myelitis with pulmonary tuberculosis:a report of 2 cases

目的探讨长节段横贯性脊髓炎(longitudinally extensive transverse myelitis,LETM)与结核杆菌感染的相关性。方法回顾性分析国内外的LETM与结核杆菌感染的相关性研究报道,就我院收治的2例合并肺结核(pulmonary tuberculosis,PTB)的LETM患者进行临床分析。结果 2例合并PTB的长节段脊髓炎患者,其中病例1,AQP4-Ab/NMO-IgG阳性,诊断为视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSDs),其EDSS最高达7.0分,给予激素联合抗结核治疗后,随访1 y后EDSS为0分,长节段脊髓病灶较治疗前显著吸收;病例2为AQP4-Ab/NMO-IgG阴性的LETM患者,其EDSS 4.5分,给予激素联合抗结核治疗后,3 m随访病情明显改善,EDSS为0分,长节段脊髓病灶较治疗前显著吸收。结论本文经验性抗结核合并激素抑制免疫反应,对此类患者具有良好的治疗作用。关于结核感染与长节段脊髓炎之间的关系,仍需要进一步研究。

Objective To investigate the correlation of longitudinally extensive transverse myelitis （LETM） and my- cobacterium tuberculosis. Methods We retrospectively analyzed relatively domestic and foreign study with regard to the correlation of LETM and mycobacterium tuberculosis. The clinical analyses were performed in 2 cases of LETM with pulmo- nary tuberculosis （PTB） in our hospital（ First Hospital of Jilin University）. Results 2 cases of LETM with PTB ： case 1 was diagnosed with neuromyelitis optica spectrum disorders （NMOSDs） , AQP4-Ab/NMO-IgG was positive and EDSS was up to 7 points. After patient received hormone combined with anti tuberculosis treatment,and followed up for 1 year EDSS was 0. The lesions of long segment spinal cord were significantly absorbed than before ; Case 2, AQP4-Ab/NMO-IgG negative pa- tient with LETM and EDSS was 4.5 points. After patient received hormone combined with anti-tuberculosis treatment and followed up for 3 months patient＇ s condition was significantly improved. EDSS was 0, the lesions of long segment spinal cord were obviously absorbed. Conclusion In this paper, empirical anti-tuberculosis combined with hormone suppress im- mune responses and has a good therapeutic effect on the patients. Further studies are needed on the relationship between mycobacterium tuberculosis and LETM.