急性横贯性脊髓炎的临床特征和治疗效果分析
发布时间：2018-11-19 13:54
【摘要】：目的：通过对111例急性横贯性脊髓炎患者的临床资料进行回顾性分析，以探讨急性横贯性脊髓炎的年龄、性别、发病诱因、临床表现、脑脊液检查、影像学检查等方面的临床特征以及不同治疗方法的效果，从而提高对急性横贯性脊髓炎的认识，为早期诊断、及时选择有效治疗方法、预测预后提供依据。 方法：本研究连续收集了2008年5月至2013年12月在河北医科大学第二医院住院的111例急性横贯性脊髓炎患者。所有病例均符合急性脊髓炎国际协作组（Transverse Myelitisconsortium Working Group，TMCWG）制定的ATM诊断标准。年龄为15~80岁，平均42.72±18.04岁。本研究详细记录了患者的年龄、性别、病前2周内感染史、临床表现、脑脊液检查、脊髓MR检查、神经电生理学检查、合并症、治疗效果。依据治疗方法不同，分为地塞米松组（30例）、甲基泼尼松龙组（29例）、甲基泼尼松龙联合丙种球蛋白组（25例），对以上三种治疗方法的疗效进行对比研究，使用SPSS16.0进行统计学分析，计数资料采用χ2检验。三组间比较，P＜0.05为差异具有统计学意义；三组内两两比较，P＜0.0167为差异具有统计学意义。 结果： 1临床特征分析 1.1一般特征 女性70例（63.1%），男女比例为1:1.7。青年（≤44岁）56例（50.5%），中年(45~59岁)30例（27%），老年（≥60岁）25例（22.5%）。病前2周内存在感染史者50例（45%）。 1.2临床表现 运动障碍者108例（97.3%），其中截瘫65例（60.2%），以截瘫为主；感觉障碍者102例（91.9%），其中存在感觉平面者100例（98%），感觉平面非对称者6例（6%）；自主神经功能障碍者92例（82.9%），，其中尿潴留85例（76.6%）。 1.3辅助检查 行腰椎穿刺者55例，其中脑脊液中白细胞升高者20例（36.4%），脑脊液中蛋白升高者29例（52.7%）；行脑脊液细胞学检查者48例，其中异常脑脊液细胞学者38例（79.2%），以淋巴细胞反应为主者34例，以嗜中性粒细胞反应为主者4例；行脊髓MRI检查者108例，其中异常93例（86.1%），病变累及颈髓者48例，病变累及胸髓者62例，病变累及腰髓者18例，病变累及骶髓者10例，脊髓水肿者39例；行脊髓MR增强者48例，其中33例（68.8%）脊髓病变部位存在增强。行视觉诱发电位检查者34例，异常15例（44.1%）；行肌电图检查者12例，异常9例（75%）。 1.4合并症 发生合并症者28例，其中泌尿系感染20例（71.4%），呼吸道感染7例（25%），压疮6例（21.4%），下肢静脉血栓3例（10.7%）。 2治疗效果 地塞米松组标准化有效率为70.2%，甲强组标准化有效率为85.7%，甲强联合丙球组标准化有效率为96.5%。三组比较，P＜0.05，可认为三种疗法治疗急性横贯性脊髓炎的有效率有差别。三组内两两比较，P＜0.0167，故可认为大剂量甲基泼尼松龙联合丙种球蛋白的疗效最佳，大剂量甲基泼尼松龙冲击疗效次之，地塞米松疗效最差。 结论： 1.本研究中急性横贯性脊髓炎患者以青年为主，女性居多；以感染后急性横贯性脊髓炎居多。 2.大多数急性横贯性脊髓炎患者存在运动障碍，以截瘫为主，与急性横贯性脊髓炎好发于胸髓相一致；多数患者存在明确的感觉障碍平面，自主神经功能障碍以尿潴留为主。 3.急性横贯性脊髓炎患者脑脊液检查少见炎性证据，而脊髓MRI检查显示病变的阳性率高。 4.急性横贯性脊髓炎的并发症以泌尿系感染多发，住院期间应注意尿液变化及会阴护理。 5.大剂量甲基泼尼松龙联合丙种球蛋白的疗效最佳，大剂量甲基泼尼松龙冲击疗效次之，地塞米松疗效最差。
[Abstract]:Objective: To analyze the clinical data of 111 patients with acute transverse myelitis, to study the age, sex, cause, clinical manifestation and cerebrospinal fluid examination of acute transverse myelitis. The clinical characteristics and the effect of different treatment methods in the aspects of image examination and the like, so as to improve the understanding of the acute transverse myelitis, provide the basis for early diagnosis, timely select the effective treatment method and predict the prognosis. Methods: In this study, 111 cases of acute transverse myelitis from May 2008 to December 2013 in the second hospital of Hebei Medical University were collected. All cases were in accordance with the ATM diagnosis developed by the International Cooperation Group (TMCWG) of the Acute Myelitis Standard. Age 15-80 years, average 42. 72-18. 0 4 years of age. The study details the patient's age, sex, history of infection in the first 2 weeks of the disease, clinical presentation, cerebrospinal fluid examination, spinal MR examination, neuroelectrophysiology examination, comorbidities, treatment, The results were divided into two groups (30 cases), methylprednisolone group (29 cases) and methylprednisolone combined group (25 cases) according to the treatment method, and the effect of the above three treatment methods was compared and studied, and the statistics of SPSS16. 0 were used. Analysis and counting data is shown in Figure 2 The difference of P <0.05 was statistically significant between the three groups, and P <0. 0167 in the three groups was statistically significant. meaning. Results: 1 Clinical features An analysis of 70 women with general characteristics (63. The ratio of male to female was 1: 1. 7. The young (aged 44) in 56 cases (50. 5%), middle-aged (45-59 years), 30 (27%), and elderly (1%). 25 (22. 5%) in the first two weeks of the disease the presence of an infection historian 5 Among the 0 cases (45%), 108 (97.3%) of the patients with the clinical manifestations of paraplegia, 65 (60.2%) of the paraplegia, and 102 (90.9%) of the patients with the sensory disturbance, of them, 100 cases of the sensory plane were found. (98%), 6 (6%), and 92 (82%).. 9%), in which There were 85 cases of lumbar puncture (76.6%) in the urine, and 55 cases of lumbar puncture with the aid of 1. 3. Among them, 20 cases (36.4%) of the white blood cell in the cerebrospinal fluid and 29 (52.7%) of the protein in the cerebrospinal fluid were examined, and the cytological examination of the cerebrospinal fluid was performed. Of the 48 cases, 38 (79.2%) of the patients with abnormal cerebrospinal fluid (CSF), 34 of the main patients with lymphocyte reaction, and 4 with the response of the neutrophils, and 108 patients with spinal cord MRI, of which, 93 (86.1%) were abnormal, and 48 cases were involved in the cervical spinal cord, and the lesion was involved in the thoracic and spinal cord. In 62 cases, 18 cases were involved in the lesion, 10 cases were involved in the lesion and 39 cases of the spinal cord edema, and the MR of the spinal cord was enhanced. Of the 48 cases, 33 (68. 8%) of the spinal cord lesions were enhanced. 34 of the subjects with visual evoked potential and 15 (4) were abnormal. 4.1%); Among the 12 patients, 9 (75%) and 1. 4 co-morbidities occurred in 28 cases, including 20 (71.4%) of urinary tract infection and 7 (7 cases) of respiratory tract infection. 25%), 6 cases (22.4%) of pressure sore and 3 cases of lower limb venous thrombosis (10.7%). The standardized effective rate of the dexamethasone group was 70. The standardized effective rate of group A was 85.7%, and the standardized effective rate was 96.5.%. Compared with the three groups, P <0.05, the effective rate of three treatments in the treatment of acute transverse myelitis was different. The two groups of the three groups were compared, P <0. 0167, so it was considered that the high dose of methylprednisolone combination of dragon and dragon The efficacy of the gamma globulin is the best, the effect of the large-dose methylprednisolone is the second, and the effect of dexamethasone is the worst. Conclusion: 1. The majority of the patients with acute transverse myelitis in the study were young and female, most of them with acute transverse myelitis after infection. Most of the patients with acute transverse myelitis were dyskinesia and paraplegia. The acute transverse myelitis is well aligned with the thoracic spinal cord; the majority of the patients have a clear plane of sensory disorder, autonomic dysfunction, Urine retention is the main factor. 3. The cerebrospinal fluid of the patients with acute transverse myelitis is rare, and the MRI of the spinal cord The results showed that the positive rate of the lesion was high. 4. The complication of acute transverse myelitis was more frequent in the urinary system, and the change of the urine should be observed during the hospitalization.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.3
本文编号：2342504
[Abstract]:Objective: To analyze the clinical data of 111 patients with acute transverse myelitis, to study the age, sex, cause, clinical manifestation and cerebrospinal fluid examination of acute transverse myelitis. The clinical characteristics and the effect of different treatment methods in the aspects of image examination and the like, so as to improve the understanding of the acute transverse myelitis, provide the basis for early diagnosis, timely select the effective treatment method and predict the prognosis. Methods: In this study, 111 cases of acute transverse myelitis from May 2008 to December 2013 in the second hospital of Hebei Medical University were collected. All cases were in accordance with the ATM diagnosis developed by the International Cooperation Group (TMCWG) of the Acute Myelitis Standard. Age 15-80 years, average 42. 72-18. 0 4 years of age. The study details the patient's age, sex, history of infection in the first 2 weeks of the disease, clinical presentation, cerebrospinal fluid examination, spinal MR examination, neuroelectrophysiology examination, comorbidities, treatment, The results were divided into two groups (30 cases), methylprednisolone group (29 cases) and methylprednisolone combined group (25 cases) according to the treatment method, and the effect of the above three treatment methods was compared and studied, and the statistics of SPSS16. 0 were used. Analysis and counting data is shown in Figure 2 The difference of P <0.05 was statistically significant between the three groups, and P <0. 0167 in the three groups was statistically significant. meaning. Results: 1 Clinical features An analysis of 70 women with general characteristics (63. The ratio of male to female was 1: 1. 7. The young (aged 44) in 56 cases (50. 5%), middle-aged (45-59 years), 30 (27%), and elderly (1%). 25 (22. 5%) in the first two weeks of the disease the presence of an infection historian 5 Among the 0 cases (45%), 108 (97.3%) of the patients with the clinical manifestations of paraplegia, 65 (60.2%) of the paraplegia, and 102 (90.9%) of the patients with the sensory disturbance, of them, 100 cases of the sensory plane were found. (98%), 6 (6%), and 92 (82%).. 9%), in which There were 85 cases of lumbar puncture (76.6%) in the urine, and 55 cases of lumbar puncture with the aid of 1. 3. Among them, 20 cases (36.4%) of the white blood cell in the cerebrospinal fluid and 29 (52.7%) of the protein in the cerebrospinal fluid were examined, and the cytological examination of the cerebrospinal fluid was performed. Of the 48 cases, 38 (79.2%) of the patients with abnormal cerebrospinal fluid (CSF), 34 of the main patients with lymphocyte reaction, and 4 with the response of the neutrophils, and 108 patients with spinal cord MRI, of which, 93 (86.1%) were abnormal, and 48 cases were involved in the cervical spinal cord, and the lesion was involved in the thoracic and spinal cord. In 62 cases, 18 cases were involved in the lesion, 10 cases were involved in the lesion and 39 cases of the spinal cord edema, and the MR of the spinal cord was enhanced. Of the 48 cases, 33 (68. 8%) of the spinal cord lesions were enhanced. 34 of the subjects with visual evoked potential and 15 (4) were abnormal. 4.1%); Among the 12 patients, 9 (75%) and 1. 4 co-morbidities occurred in 28 cases, including 20 (71.4%) of urinary tract infection and 7 (7 cases) of respiratory tract infection. 25%), 6 cases (22.4%) of pressure sore and 3 cases of lower limb venous thrombosis (10.7%). The standardized effective rate of the dexamethasone group was 70. The standardized effective rate of group A was 85.7%, and the standardized effective rate was 96.5.%. Compared with the three groups, P <0.05, the effective rate of three treatments in the treatment of acute transverse myelitis was different. The two groups of the three groups were compared, P <0. 0167, so it was considered that the high dose of methylprednisolone combination of dragon and dragon The efficacy of the gamma globulin is the best, the effect of the large-dose methylprednisolone is the second, and the effect of dexamethasone is the worst. Conclusion: 1. The majority of the patients with acute transverse myelitis in the study were young and female, most of them with acute transverse myelitis after infection. Most of the patients with acute transverse myelitis were dyskinesia and paraplegia. The acute transverse myelitis is well aligned with the thoracic spinal cord; the majority of the patients have a clear plane of sensory disorder, autonomic dysfunction, Urine retention is the main factor. 3. The cerebrospinal fluid of the patients with acute transverse myelitis is rare, and the MRI of the spinal cord The results showed that the positive rate of the lesion was high. 4. The complication of acute transverse myelitis was more frequent in the urinary system, and the change of the urine should be observed during the hospitalization.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.3
【引证文献】
相关期刊论文 前1条
1 张宏菊;;探讨急性脊髓炎的临床特征以及激素联合中药治疗临床效果[J];环球中医药;2015年S2期
本文编号：2342504
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