脊髓亚急性联合变性的临床特点及早期联合诊断(附18例报告)

doi:10.13481/j.1671-587x.20180421

吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (04): 806-809.doi: 10.13481/j.1671-587x.20180421

脊髓亚急性联合变性的临床特点及早期联合诊断(附18例报告)

杜娜, 毛西京, 于挺敏, 姚刚

吉林大学第二医院神经内科, 吉林长春 130041

收稿日期:2017-11-13 出版日期:2018-07-28 发布日期:2018-07-27
通讯作者: 姚刚,副主任医师,硕士研究生导师(Tel:0431-81136816,E-mail:yaogang0431@163.com) E-mail:yaogang0431@163.com
作者简介:杜娜(1992-),女,山东省聊城市人,医师,在读医学硕士,主要从事神经内科临床方面的研究。
基金资助:
国家自然科学基金资助课题（81500953）；吉林省科技厅科技发展计划项目资助课题（20150520143JH）

Clinical manifestations and early combined diagnosis of subacute combined degeneration of spinal cord:A report of 18 cases

DU Na, MAO Xijing, YU Tingmin, YAO Gang

Department of Neurology, Second Hospital, Jilin University, Changchun 130041, China

Received:2017-11-13 Online:2018-07-28 Published:2018-07-27

摘要/Abstract

摘要： 目的：探讨脊髓亚急性联合变性（SCD）的临床特点及早期联合诊断。方法：收集18例SCD患者的临床资料，分析SCD患者临床表现，检测血清维生素B12（VB12）、同型半胱氨酸（Hcy）和平均血红蛋白（MCH）水平及平均红细胞体积（MCV），进行电生理检查并分析其异常表现。结果：18例SCD患者中临床表现肢体麻木者12例，运动障碍者10例，视物模糊者1例，精神异常者4例，尿便障碍者2例。18例患者中血清VB12水平降低者9例（50.0%），Hcy水平升高者18例（100%），MCV升高者15例（83.3%），MCH水平升高者14例（77.8%），15例患者行神经电生理检查，结果均有阳性发现。结论：SCD患者缺乏特征性临床表现，根据血清VB12缺乏诊断率较低，联合检测Hcy、MCH和MCV水平及电生理检查对SCD早期诊断有重要意义。

关键词: 脊髓亚急性联合变性, 同型半胱氨酸, 神经电生理, 维生素B12, 平均红细胞体积

Abstract: Objective:To discuss the clinical manifestations and early combined diagnosis of subacute combined degeneration(SCD)of the spinal cord. Methods:The clinical data of 18 patients with SCD were collected,and the clinical manifestations and the levels of serum vitamin B12(VB12)and homocysteine(Hcy),mean corpuscular hemoglobin(MCH) levels,and mean corpuscular volume (MCV) were detected.The abnormal appearence of electrophysiological examination of the SCD patients was analyzed. Results:There were 12 cases of limb numbness in 18 SCD patients,10 cases of motor disturbance,1 case of blurred vision,4 cases of mental abnormality,and 2 cases of urinary disturbance.Among the 18 patients,the serum VB12 levels were decreased in 9 cases (50.0%),the Hcy levels were increased in 18 cases (100%),the MCV were increased in 15 cases(83.3%) and the MCH levels were increased in 14 cases (77.8%).The results of neuroelectrophysiological examination in 15 patients were all positive. Conclusion:The patients with SCD lack of the characteristic clinical manifestations.The diagnosis rate of SCD is low by the lack of serum VB12,and the combined detection of serum VB12,Hcy,MCV,MCH and electrophysiological examination is of great significance for the early diagnosis of SCD.

Key words: homocysteine, subacute combined degeneration of spinal cord, mean corpuscular volume, vitamin B12, neuroelectrophysiology

中图分类号:

R744.6

杜娜, 毛西京, 于挺敏, 姚刚. 脊髓亚急性联合变性的临床特点及早期联合诊断(附18例报告)[J]. 吉林大学学报(医学版), 2018, 44(04): 806-809.

DU Na, MAO Xijing, YU Tingmin, YAO Gang. Clinical manifestations and early combined diagnosis of subacute combined degeneration of spinal cord:A report of 18 cases[J]. Journal of Jilin University Medicine Edition, 2018, 44(04): 806-809.

参考文献

[1] Wong CW.Vitamin B12 deficiency in the elderly:is it worth screening[J].Hong Kong Med J,2015,21(2):155.
[2] Rizzo G,Lagana AS,Rapisarda AM,et al.Vitamin B12 among vegetarians:status,assessment and supplementation[J].Nutrients,2016,8(12):767.
[3] Roessler FC,Wolff S.Rapid healing of a patient with dramatic subacute combined degeneration of spinal cord:a case report[J].BMC Res Notes,2017,10(1):18-19.
[4] 李楠,王璐,王苏平.血清维生素B12水平正常的脊髓亚急性联合变性患者临床特点[J].山东医药,2018,58(4):74-76.
[5] Franques J,Chiche L,Mathis S.Sensory neuronopathy revealing severe vitamin B12 deficiency in a patient with anorexia nervosa:an often-forgotten reversible cause[J].Nutrients,2017,9(3):281-282.
[6] 邱志茹,刘洪波,王少平,等.神经电生理检查在脊髓亚急性联合变性中的诊断应用[J].中国实用神经疾病杂志,2013,5(9):6-8.
[7] 金娟,李妍,朱皓月,等.脊髓亚急性联合变性患者临床神经损害相关因素及电生理特点分析[J].中国医科大学学报,2016,45(8):715-718.
[8] 吴江.神经病学[M].北京:人民卫生出版社,2015:159-160.
[9] Sun G,Shi YB.Thyroid hormone regulation of adult intestinal stem cell development:mechanisms and evolutionary conservations[J].Int J Biol Sci,2012,8(8):1217-1224.
[10] Lee WJ,Hsu HY,Wang PY.Reversible myelopathy on magnetic resonance imaging due to cobalamin deficiency[J].J Chin Med Assoc,2008,71(7):368-372.
[11] Puri V,Chaudhry N,Gulati P.Syringomyelia-like manifestation of subacute combined degeneration[J].J Clin Neurosci,2004,11(6):672-675.
[12] Kapadia C.Cobalamin (Vitamin B12)deficiency:it is a problem compounded by drugs that inhibit gastricacid secretion[J].J Clin Gastroenterol,2000,30(1):4-6.
[13] 毕鸿雁,张芹,赵亚明,等.脊髓亚急性联合变性24例临床分析[J].中国神经免疫学和神经病学杂志,2014,21(4):254-256.
[14] Gursoy AE,Kolukisa M,Babacan-Yildiz G,et al.Subacute combined degeneration of the spinal cord due to different etiologies and improvement of MRI findings[J].Case Rep Neurol Med,2013,2013:159649.
[15] 杨奎,陈军,刘宁,等.36例脊髓亚急性联合变性临床资料分析[J].卫生职业教育,2012,30(20):142-144.
[16] Maamar M,Mezalck ZT,Harmouche H,et al.Contribution of spinal MRI for unsuspected cobalamin deficiency in isolated subacute combined degeneration[J].Eur J Intern Med,2008,19(2):143-145.
[17] 姜明,胡洪涛,闫欣,等.亚急性联合变性病程不同时期MRI上病灶出现率及临床表现的差别[J].中风与神经疾病杂志,2013,30(3):222-225.
[18] Gupta PK,Gupta RK,Garg RK,et al.DTI correlates ofcognifion in conventional MRI of normal-appearing brain in patients with cilinical features of subacute eombined degeneration and bioehemieally proven vitamin B12 deficiency[J].AJNR Am J Neuroradiol,2014,35(5):872-877.
[19] Shou YH,Li CF,Fan D,et al.Diagnosis and clinical manifestations of subacute combined degeneration of the spinal cord:Analysis of 21 cases[J].Neural Regen Res,2007,2(2):112-116.
[20] Vlasveld LT,Bos GM,Ermens AA,et al.Hyperhomocysteinemia and functional cobalamin deficiency due to granulocytosis-induced alterations in the cobalamin-binding protein[J].Haematologica,2006,91(3):394-396.

脊髓亚急性联合变性的临床特点及早期联合诊断(附18例报告)

Clinical manifestations and early combined diagnosis of subacute combined degeneration of spinal cord:A report of 18 cases

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 7

Metrics

本文评价

推荐阅读 0

[1]	徐吉光, 李宇宁. 叶酸联合维生素B12对高同型半胱氨酸血症引起大鼠动脉粥样硬化的治疗作用[J]. 吉林大学学报(医学版), 2017, 43(05): 943-947.
[2]	王斌, 宋红梅, 于明鑫, 李蕴潜. 神经电生理监测在面神经微血管减压术中的应用[J]. 吉林大学学报(医学版), 2015, 41(06): 1264-1269.
[3]	于秀艳, 王文龙, 吴雪峰, 刘晓峰. 非小细胞肺癌患者血清叶酸、同型半胱氨酸和维生素B₁₂的检测及其临床意义[J]. 吉林大学学报(医学版), 2015, 41(06): 1235-1238.
[4]	张研, 崔巍, 温言, 王清. 2型糖尿病肾病患者血清胱抑素C和同型半胱氨酸水平的检测及其临床意义[J]. 吉林大学学报(医学版), 2015, 41(05): 998-1003.
[5]	. 阿托伐他汀对同型半胱氨酸作用下人脐静脉内皮细胞Bcl-2启动子区甲基化水平的影响及其抗动脉粥样硬化机制[J]. 吉林大学学报(医学版), 2014, 40(05): 1002-1006.
[6]	孙晓宇，何钟勤，刘晓红，高心，钟丞，薛莹. 殊异韦荣菌sahH基因的克隆、表达和纯化[J]. 吉林大学学报(医学版), 2013, 39(4): 704-709.
[7]	于挺敏，满玉红, 吴杰. 甲基维生素B12对反复前脑缺血再灌注后的脑保护作用[J]. J4, 2006, 32(3): 390-392.