老年人脊髓亚急性联合变性的临床分析

发布时间：2018-09-04 12:54

【摘要】：目的探讨老年脊髓亚急性联合变性(subacute combined degeneration of the spinal cord,SCD)患者的病因、临床特征、治疗及预后。方法选择17例SCD老年患者,对其病因、临床表现、辅助检查、治疗及预后等进行回顾性分析。结果老年SCD患者的男女患病率无显著差异;既往甲状腺疾病患者6例(35.3%),胃疾病史5例(29.4%),吸烟史5例(29.4%),长期素食4例(23.5%);感觉异常15(88.2%),共济失调症状12例(70.6%),精神智能症状12例(70.6%);体征以闭目难立征试验阳性16例(94.1%)和位置觉、振动觉减退15例(88.2%);10例提示巨幼细胞性贫血(58.8%),6例促甲状腺激素升高(35.3%);脊髓MRI示7例有脊髓损害表现(41.2%),17例治疗前行神经电生理检测均发现异常(100.0%);所有患者予以甲钴胺和维生素B1治疗后均有不同程度好转。结论老年人SCD发病与甲状腺疾病、胃部疾病等相关;以感觉异常、共济失调多见,易出现精神智能症状;巨幼细胞贫血阳性率高;MRI与神经电生理检查有助于诊断;早诊断、早治疗利于预后。
[Abstract]:Objective to investigate the etiology, clinical features, treatment and prognosis of senile patients with subacute combined spinal cord degeneration (subacute combined degeneration of the spinal cord,SCD). Methods the etiology, clinical manifestation, adjuvant examination, treatment and prognosis of 17 elderly patients with SCD were retrospectively analyzed. Results there was no significant difference between male and female in elderly patients with SCD. There were 6 cases (35.3%) of previous thyroid diseases, 5 cases (29.4%) of gastric diseases, 5 cases (29.4%) of smoking, 4 cases (23.5%) of long-term vegetarianism, 15 cases (88.2%) of sensory abnormalities, 12 cases (70.6%) of ataxia, 12 cases (70.6%) of mental intelligence, 16 cases (94.1%) of positive signs with closed eyes and difficult to stand up test, and 16 cases (94.1%) of position perception. 15 cases (88.2%) of vibratory hypothermia, 10 cases of megaloblastic anemia (58.8%), 6 cases of thyroid stimulating hormone elevation (35.3%), 7 cases of spinal cord MRI showed spinal cord damage (41.2%), 17 cases showed abnormal neurophysiological examination before treatment (100.0%), all patients were treated with mecobalamin. And vitamin B _ 1 were improved to some extent after treatment. Conclusion the incidence of SCD in the elderly is related to thyroid disease, gastric diseases, sensory abnormalities, ataxia, mental intelligence symptoms, high positive rate of megaloblastic anemia and neuroelectrophysiological examination. Early treatment is good for prognosis.
【作者单位】：赣南医学院第一附属医院神经内科;
【分类号】：R744.6

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