54例脊髓亚急性联合变性短期随访的回顾性分析

A retrospective study of 54 cases with subacute combined degeneration of the spinal cord by short-term follow-up

目的回顾性分析脊髓亚急性联合变性(SCD)患者的临床特点、实验室检查结果、神经影像学表现以及预后。方法收集54例SCD患者,均已给予不少于6个月的维生素B12治疗。采用功能障碍评定量表对患者入院时和6个月后的症状体征进行评分,并对患者的临床表现、营养状况、血液检查结果和脊髓MRI表现进行分析。结果肢体麻木是SCD患者最常见的首发症状,发生早于运动症状(P<0.05)。所有患者在给予维生素B12治疗后均有不同程度的临床改善。入院或6个月后随访时分别按性别、年龄、脊髓MRI表现、Hb、血清维生素B12和同型半胱氨酸水平分组,功能障碍评分均无统计学差异(均P>0.05)。营养不良组入院及6个月后随访时的功能障碍评分均显著高于非营养不良组(P<0.05)。短病程组入院6个月后随访时的功能障碍评分显著低于长病程组(P<0.05)。结论SCD患者的感觉症状发生早于运动症状。营养状况和病程与SCD患者的神经功能损害程度相关。病程越短、非营养不良的SCD患者短期预后可能越好。

Objective To retrospective analyze the clinical characteristics,laboratory test results,neuroimaging findings,and outcomes in patients diagnosed with subacute combined degeneration(SCD).Methods A total of 54 patients with SCD who had been appropriately treated for no less than 6 months were included.Clinical signs and symptoms were graded by a functional disability rating scale at the time of admission and 6 months after admission.Clinical feature,nutritional status,results of blood tests,and spinal MRI findings from the patients were studied.Results Limb numbness was the most common initial symptom in patients with SCD,occurred earlier than motor symptoms(P<0.05).All patients showed clinical improvement to different degrees after vitamin B12 treatment.No statistical differences in rating score were found in patients grouped by sex,age,spinal MRI manifestations,hemoglobin,serum vitamin B12,and homocysteine level,at the time of admission or 6 minths after admission(all P>0.05).The malnutrition group had significantly worse rating scores than the non-malnutrition group at the time of admission and 6 minths after admission(P<0.05).The short course group had significantly lower rating scores than the long course patients 6 minths after admission(P<0.05).Conclusions The sensory symptoms occur earlier than the motor symptoms in SCD patients.The nutritional status and course of disease associated with neurological impairment,the shorter duration of illness and non malnutrition may lead to better prognosis of patients with SCD in the short term.