脊髓亚急性联合变性的临床和神经电生理特征分析

Clinical and electrophysiological characteristics of subacute combined degeneration of the spinal cord

目的:探讨脊髓亚急性联合变性(subacute combined degeneration of spinal cord,SCD)患者的临床及神经电生理特点。方法:回顾性分析2018年1月至2020年3月复旦大学附属中山医院厦门医院收治的12例SCD患者的临床表现、实验室检查结果、神经电生理特点、磁共振表现及随访结果。结果:12例患者中,有全胃切除史5例,慢性浅表性胃炎3例,长期素食者3例,长期饮酒者1例。9例肢体麻木,12例均走路不稳,10例感觉体征阳性,12例均闭目难立征阳性,6例病理征阳性。巨幼细胞性贫血9例,血浆维生素B 12降低11例,叶酸降低1例,12例均同型半胱氨酸升高。9例可见脊髓T 2高信号,11例神经电生理检查异常。所有患者均给予维生素B 12或甲钴胺治疗,治疗后临床症状均好转。结论:维生素B 12缺乏是SCD的最主要病因;对于有胃病史、长期饮酒及长期素食的人群,联合测定血常规、维生素B 12、同型半胱氨酸,完善神经电生理、颈胸椎磁共振,有助于提高SCD的诊断率;早期诊断并早期给予维生素B 12有助于改善SCD症状。

Objective:To explore the clinical and electrophysiological characteristics of patients with subacute combined degeneration of spinal cord(SCD).Methods:The clinical manifestations,laboratory examination results,electrophysiological characteristics,and MRI and follow-up data of 12 SCD patients diagnosed and treated in the Xiamen Branch,Zhongshan Hospital,Fudan University from January 2018 to March 2020 were retrospectively analyzed.Results:Of the 12 patients,5 had a history of total gastrectomy,3 had chronic superficial gastritis,3 had a long-term vegetarian history,1 had a long-term drinking history;9 had limb numbness,12 had unsteady walking,10 had sensation signs,12 had Romberg sign,6 had pathologic reflexes;9 had megaloblastic anemia,11 had plasma vitamin B 12 deficiency,1 had folic acid deficiency,12 had homocysteine increased;9 had T 2 hyperintensity in the spinal cord and 11 had abnormal electrophysiological manifestation.All patients were treated with vitamin B 12 or mecobalamin,and the clinical symptoms were improved after treatment.Conclusions:Vitamin B 12 deficiency is the main cause of SCD.For people with a history of gastric disease,long-term drinking,and long-term vegetarian diet,combined blood routine test,vitamin B 12,homocysteine,electrophysiological examination,and cervical and thoracic magnetic resonance imaging are helpful to improve the diagnosis rate of SCD.Early diagnosis and early vitamin B 12 treatment can help improve SCD symptoms.