多系统萎缩的临床症状及早期诊断的价值体会

The Clinical Symptoms of Multiple System Atrophy and the Value of Early Diagnosis

目的探讨多系统萎缩的临床症状及早期诊断的价值。方法选取该院24例多系统萎缩病例进行回顾性分析,时间区间为2017年5月—2018年5月。8例多系统萎缩患者以MSA-P(帕金森综合征)为对照组;16例多系统萎缩患者以MSA-C(小脑性共济失调)为观察组。对比两组患者首发症状及临床特点。结果MSA-P组首发症状包括头晕、运动迟缓、震颤、肌强直、行走不稳;MSA-C组首发症状包括头晕、行走不稳、构音障碍、下肢无力、肌强直;MSA-P组自主神经功能障碍头晕例数为1例(12.50%),便秘例数为2例(25.00%),体位性低血压2例(25.00%)。帕金森症状震颤例数为4例(50.00%),肌强直例数为6例(75.00%),运动迟缓7例(87.50%),姿势步态异常3例(37.50%)。小脑共济失调症状行走不稳例数为3例(37.50%),下肢无力1例(12.50%),颅脑磁共振小脑、脑桥萎缩2例(25.00%),第四脑室脑桥小脑脚环池扩1例(12.50%),大脑半球萎缩例数为5例(62.50%)。MSA-C组自主神经功能障碍头晕例数为12例(75.00%),便秘例数为5例(31.25%),体位性低血压10例(62.50%)。帕金森症状震颤例数为3例(18.70%),肌强直例数为2例(12.50%),运动迟缓4例(25.00%),姿势步态异常2例(12.50%)。小脑共济失调症状行走不稳例数为14例(87.50%),下肢无力8例(50.00%),颅脑磁共振小脑、脑桥萎缩9例(56.25%),第四脑室脑桥小脑脚环池扩5例(31.25%),大脑半球萎缩例数为2例(12.50%)。结论多系统萎缩无特殊治疗方法,预后差,少数药物一定程度上可改善部分多系统萎缩患者临床症状。

Objective To investigate the clinical symptoms and early diagnosis of multi-system atrophy.Methods A retrospective analysis of 24 cases of multiple system atrophy in our hospital was performed.The time interval was from May 2017 to May 2018.Eight patients with multiple system atrophy were treated with MSA-P (Parkinson's syndrome) as the control group;16 patients with multiple system atrophy were treated with MSA-C (cerebellar ataxia).The first symptoms and clinical features of the two groups were compared.Results The first symptoms in the MSA-P group included dizziness,bradykinesia,tremor,muscle rigidity,and unstable walking.The first symptoms in the MSA-C group included dizziness,unstable walking,dysarthria,lower extremity weakness,and muscle rigidity;MSA-P group of the number of dizziness in autonomic dysfunction was 1 case (12.50%),the number of constipation cases was 2 cases (25.00%),and orthostatic hypotension was 2 cases (25.00%).The number of Parkinson's symptoms of tremor was 4 (50.00%),the number of myotonia was 6 cases(75.00%),7 cases(87.50%) were retarded,and 3 cases(37.50%) were abnormal gait.Cerebellar ataxia symptoms were unstable in 3 cases (37.50%),lower extremity weakness in 1 case (12.50%),brain magnetic resonance cerebellum,pons atrophy in 2 cases (25.00%),fourth ventricle pons cerebellar foot ring pool of 1 case (12.50%),the number of cases of cerebral hemisphere atrophy was 5 cases(62.50%).The number of dizziness in autonomic dysfunction in MSA-C group was 12 cases(75%),5 cases in constipation (31.25%),and 10 cases in orthostatic hypotension (62.50%).The number of Parkinson's symptom tremors was 3 cases (18.70%),the number of myotonia was 2 cases(12.50%),4 cases (25.00%) were retarded,and 2 cases (12.50%) were abnormal gait.The cerebellar ataxia symptoms were unstable in 14 cases (87.50%),lower extremity weakness in 8 cases (50.00%),cranial magnetic resonance cerebellum,pons atrophy in 9 cases (56.25%),fourth ventricle pons cerebellar foot ring pool of 5 cases (31.25%),the number of cases of cerebral hemisphere atrophy was 2 cases (12.50%).Conclusion There is no special treatment for multi-system atrophy,and the prognosis is poor.A few drugs can improve the clinical symptoms of some patients with multiple system atrophy.