83例多发性硬化患者临床分析

Clinical Analysis of 83 Patients with Multiple Sclerosis

目的总结我院83例多发性硬化(MS)患者发病特点及用药情况,为临床医师诊治MS提供参考。方法选取内蒙古自治区人民医院2021年10月至2022年10月首次确诊的MS患者及门诊复诊患者,按发病年龄分为未成年组(<18岁)、青年组(18~44岁)及中老年组(≥45岁),从流行病学、临床特点、诊疗情况等进行回顾性分析,对比随访3个月前后EDSS、MOCA、MMSE、MSIS-29功能评分变化。结果共入组83例患者,首发运动症状为16例(19.3%)、感觉症状43例(51.8%)、视觉障碍11例(13.3%)、共济失调5例(6.0%)、其他症状8例(9.6%)。(1)EDSS、MSIS-29评分三组间比较,差异无统计学意义(P>0.05);随访3个月后,与就诊时相比EDSS、MSIS-29评分差异具有统计学意义(P<0.05),且EDSS、MSIS-29评分均为中老年组显著大于未成年组,用药组与未用药组比较,差异有统计学意义(P<0.05)。(2)MoCA、MMSE评分三组间比较,差异均有统计学意义(P<0.05);随访3个月后差异均有统计学意义(P<0.05),且MoCA评分中老年组小于未成年组、青年组,随访前后比较,差异均无统计学意义(P>0.05)。(3)有无DMT治疗两组间EDSS、MSIS-29评分比较,差异均有统计学意义(P<0.05),且无DMT治疗组大于用药组。(4)MMSE、MoCA评分就诊时、3个月后认知障碍率比较,差异均有统计学意义(P<0.05),且均为中老年组高于青年组,未成年组最低。结论早期用DMT治疗有利于改善EDSS、MSIS-29评分,由于随访时间较短,MMSE评分、MoCA评分无明显改善。治疗方面,DMT药物的使用呈上升趋势。

Objective To summarize the pathogenesis and medication of 83 patients with multiple sclerosis(MS)in our hospital,and to provide reference for the diagnosis and treatment of MS by clinicians.Methods Patients with MS diagnosed for the first time and patients with outpatient revisit in Inner Mongolia People's Hospital from October 2021 to October 2022 were selected and divided into juvenile group(<18 years old),youth group(18~44 years old)and middle-aged and elderly group(≥45 years old)according to the age of onset.A retrospective analysis was conducted based on epidemiology,clinical characteristics,current diagnosis and treat⁃ment.The functional scores of EDSS,MOCA,MMSE and MSIS-29 were compared before and after 3 months of follow-up.Results A total of 83 patients were enrolled.The proportion of relapse-remitting types(RRMS)was 81.9%,that of secondary progressive types(SPMS)was 15.6%,and that of unclassified types was 2.4%.16 cases(19.2%)had first motor symptoms,43 cases(51.8%)had sensory symptoms,and 11 cases(13.2%)had visual impairment.There were 5 cases(6.0%)of ataxia and 8 cases(9.6%)of other symptoms.(1)Com⁃parison of EDSS score and MSIS-29 scale among the three groups showed no statistical significance(P<0.05);After 3 months of follow-up,there were statistically significant differences in EDSS score and MSIS-29 scale compared with the treatment(P<0.05),and the EDSS and MSIS-29 in the elderly group were significantly higher than those in the juvenile group,and the differences were statistically significant between the treated group and the untreated group(P<0.05).(2)Comparison of the MoCA and MMSE scales among the three groups showed statisti⁃cally significant differences(P<0.05);After 3 months of follow-up,the differences were statistically significant(P<0.05),and the MoCA of the middle-aged and elderly group was smaller than that of the juvenile group and the youth group,there was no statistical significance before and after follow-up(P>0.05).(3)There were statistical⁃ly significant differences in EDSS and MSIS-29 scores between the two groups with or without DMT treatment(P<0.05),and the DMT treatment group was greater than the drug group.(4)There were statistically significant differ⁃ences in the rates of cognitive impairment at the time of treatment and after 3 months with MMSE and MoCA scales(P<0.05),and the elderly group was higher than the youth group,and the juvenile group was the lowest.Conclu⁃sion Early treatment with DMT can improve EDSS score and MSIS-29 scale.Due to short follow-up time,there is no significant improvement in MMSE scale and MOCA scale.In terms of treatment,the use of DMT drugs is on the rise.