摘要
目的探讨壁细胞抗体(PCA)阳性的脊髓亚急性联合变性(SCD)临床特征,为SCD早期诊断提供参考。方法回顾性分析2020年12月至2022年2月安徽医科大学第一附属医院神经内科收治的13例SCD患者临床资料。结果13例患者均以麻木无力症状起病,查体可见周围神经和脊髓受累的阳性体征,其中10例存在巨幼细胞贫血,8例维生素B_(12)水平降低,11例同型半胱氨酸(Hcy)水平升高,13例PCA阳性,8例内因子抗体(IFA)阳性,10例脊髓核磁共振(MRI)见脊髓异常病灶,9例脑MRI见白质异常信号,11例神经电生理检查见多发周围神经损害,2例胃镜见萎缩性胃炎。给予患者维生素B_(1)和维生素B_(12)肌肉注射,3个月后随访,病程6个月以内的9例患者无神经系统遗留症状,其余患者仍有麻木和/或无力。结论SCD诊断不能仅依靠维生素B_(12)水平、脊髓MRI和神经电生理检查,结合PCA、IFA和Hcy有助于提高SCD的诊断率。
Objective To analyze the clinical features of subacute combined degeneration(SCD)of the spinal cord with positive parietal cell antibody(PCA)for early diagnosis.Methods The clinical data of 13 SCD patients from the Department of Neurology of the First Affiliated Hospital of Anhui Medical University from December 2020 to February 2022 were analyzed retrospectively.Results All the patients presented with the initial symptoms of numbness and weakness and the signs of the peripheral nerves and the spinal cord.10 patients had megaloblastic anemia,8 cases had low levels of vitamin B_(12),11 cases had hyperhomocysteinemia,13 cases had positive PCA and 8 cases had positive IFA.The abnormal lesions of spinal cord were present in 10 patients,and the white matter lesions were present in 9 cases.Neurophysiological findings were abnormal in 11 patients.Atrophic gastritis were found by gastroscopy in 2 patients.The patients were treated with vitamin B_(1)and vitamin B_(12).After 3 months follow-up,9 patients with the disease course less than 6 months had no symptoms of nervous system,and the rest of the patients still had numbness and/or weakness.Conclusions The diagnosis of SCD cannot only rely on the vitamin B_(12)levels,spinal cord MRI and neurophysiological examinations.PCA,IFA and Hcy can improve the diagnosis of SCD for early treatment and a good prognosis.
作者
史秀丽
章娟娟
周农
田仰华
SHI Xiuli;ZHANG Juanjuan;ZHOU Nong;TIAN Yanghua(Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《安徽医学》
2023年第1期44-47,共4页
Anhui Medical Journal
基金
国家自然科学基金项目(编号:32071054,81901135)。
