62例视神经脊髓炎患者临床特点分析

发布时间：2018-04-08 17:03

本文选题：视神经脊髓炎　切入点：Devic病　出处：《中国人民解放军军医进修学院》2010年硕士论文

【摘要】： 目的：通过对62例视神经脊髓炎患者进行详细的病史采集、眼科以及神经内科临床检查、眼科辅助检查、影像学检查等分析,参照国际认可的诊断标准明确诊断,并通过血液、脑脊液等实验室检查指标,分析视神经脊髓炎患者的发病过程,以减少临床误诊和漏诊。并对患者进行长期随访,追踪了解疾病的复发情况及转归。探讨分析视神经脊髓炎的单时相病程及多时相病程与疾病诊断、治疗的关系,以期为临床早期诊断及预后判断提供帮助。方法：回顾性分析2000-2009年于解放军总医院收治的62例视神经脊髓炎病例,共110眼。对其临床资料收集后分析,其中包括年龄、性别、首发症状、视神经炎和脊髓炎的体征及既往诊疗情况进行总结分析。患者入院后详细询问病史,并行视力、视野、眼底、VEP等各项眼科及辅助检查,必要时行眼底荧光血管造影、MRI等影像学检查,神经内科会诊行常规检查必要时做腰穿,并行血常规、血沉、血糖、肝肾功能、激素水平、类风湿因子、免疫因子、血液NMo-IgG、脑脊液生化、常规等实验室检查。根据各项检查结果,参照1999年Wingerchuk等制定的诊断标准对患者明确诊断。结果：本组视神经脊髓炎患者中,男15例(24.2%),女47例(75.8%),男女比例1：3。发病年龄3-69岁,平均(39.44±4.28)岁,20-59岁占发病人数74%。,单眼受累14例(23%),双眼受累48例(77%),单时相病程者15例(24.2%),多时相病程者47例(75.8%),病程最短30天,最长20年。双侧视神经炎和脊髓炎同时或相继很快发生,常预示单时相病程,单时相发病时临床表现比复发型重,而预后好。多时相病程首发为视神经炎或脊髓炎任一单独事件,女性、发病年龄晚、首次发作脊髓炎运动障碍或视力降低相对轻是其特征(P值分别为0.057,0.122)。62例NMO均表现为急性或亚急性起病的单侧或双侧视神经或脊髓损害症状而无其他部位受损。视神经炎病程在1-3个月的患者中视神经萎缩发生率为67.7%,病程3个月时视神经萎缩发生率上升到90%。病程在1-3个月和3个月组是神经萎缩的发病率均明显高于1个月组(P=0.011,P0.05)。43例VEP检查结果显示42例结果异常,异常率达98%。62例MRI结果中,脊髓损伤平面在颈段者35例(56.45%),胸段者17例(27.42%),腰段者3例(4.84%),未见异常7例(11.29%)。病灶位于颈、胸髓比率高,具有节段长易合并坏死等特点。结论：NMO患者的神经系统症状和体征局限于视神经和脊髓,受累达100%,临床表现严重,多呈横贯性脊髓损害,首次发作中痛温觉障碍明显,预后差。其患病率逐年上升,女性患者比例高,临床以视力下降为首发者多见,多以双眼发病多,视力减退明显,患眼表现为不同程度视野缺损、瞳孔散大、RAPD(+)。病程大于3个月患者神经萎缩的发生率高,在未出现脊髓炎症状前确诊困难,易误诊为球后视神经炎、视神经炎乳头炎及视神经萎缩,漏诊率为93%。脊髓炎首发者VEP检查有助于确诊。头颅MRI及血液NMO-IgG为提高确诊率及评价预后提供了强有力证据,具有广泛的临床价值。NMO可分为单时相型和多时相型,女性、发病年龄晚、索引事件间隔长可能与复发病程有关。NMO可能的病因分为外因(环境因素)与内因两大类,鉴于其复杂性,应进行大样本、多中心的长期随访研究,来对NMO的诊断治疗进行系统评价。
[Abstract]:Objective: to carry on the detailed history of 62 cases of patients with neuromyelitis optica, ophthalmology and neurology clinical examination, ophthalmic examination, imaging examination and analysis, according to the international diagnostic criteria for diagnosis, and through the blood, cerebrospinal fluid and other laboratory examination index, analysis of the pathogenesis of patients with neuromyelitis optica. In order to reduce the clinical misdiagnosis and missed diagnosis. And the long-term follow-up of patients with recurrence and prognosis, to track disease. Analysis on the Dan Shixiang course of neuromyelitis optica and temporal course of disease and disease diagnosis, treatment of the relationship, in order to provide help for the early clinical diagnosis and prognosis.
Methods: a retrospective analysis of 2000-2009 years in the PLA general hospital treated 62 cases of neuromyelitis optica cases, 110 eyes. The clinical data collection and analysis, including age, gender, symptoms, signs and previous treatment of optic neuritis and myelitis were retrospectively analyzed. Patients admitted to the hospital after a detailed history in parallel, vision, vision, fundus, VEP and other eye examinations and, if necessary, fundus fluorescein angiography, MRI imaging examination, neurology consultation routine check when necessary to do a lumbar puncture, parallel blood, erythrocyte sedimentation rate, blood glucose, liver and kidney function, hormone level, rheumatoid factor, immune factor, blood NMo-IgG, CSF biochemistry. Routine test. According to the result of the examination, according to diagnostic criteria established by Wingerchuk in 1999 of patients with definite diagnosis.
Results: this group of patients with neuromyelitis optica, 15 cases were male (24.2%), 47 cases were female (75.8%), the proportion of men and women 1:3. the average age of 3-69 years (39.44 + 4.28) years old, 20-59 years old accounted for the incidence of 74%., unilateral involvement in 14 cases (23%), were involved in 48 cases (77%). 15 cases of Dan Shixiang disease patients (24.2%), 47 cases of temporal course of disease (75.8%), the shortest duration of 30 days, the longest 20 years. Bilateral optic neuritis and myelitis simultaneously or successively occur very quickly, often indicates that single phase duration, while the onset of clinical manifestations and prognosis of relapsing than. Good. The first course of multitemporal optic neuritis encephalomyelitis or any individual event, female, age of onset of late onset spinal cord dyskinesia or reduce vision is characterized by relatively light (P = 0.057,0.122).62 NMO showed acute or subacute onset of unilateral or bilateral optic nerve or spinal cord injury symptoms and no other damaged parts. The course of optic neuritis incidence was 67.7% in 1-3 months in patients with atrophy of optic nerve, the course of disease was 3 months when the optic nerve atrophy rate rose to 90%. in the course of 1-3 months and 3 months were atrophy incidence rate were significantly higher than that in 1 months group (P=0.011, P0.05) the results of.43 VEP showed the results 42 cases of abnormal, abnormal rate of 98%.62 patients with MRI results, 35 cases of cervical spinal cord injury in the plane segment (56.45%), 17 cases of thoracic (27.42%), 3 cases of lumbar (4.84%), 7 cases were abnormal (11.29%). The lesions were located in cervical and thoracic spinal cord has the characteristics of high rate section Changyi and necrosis.
Conclusion: NMO patients with neurological signs and symptoms confined to the optic nerve and spinal cord involvement, 100%, clinical manifestations were serious, transverse spinal cord injury, for the first time aesthema disturbance obviously, poor prognosis. Its prevalence increased year by year, the proportion of female patients, clinical with visual acuity decrease as the first round to see more. In the binocular incidence, significantly decreased visual acuity, eyes showed varying degrees of visual field defect, mydriasis, RAPD (+). The course of more than 3 months of atrophy of nerve in patients with high incidence of spinal arthritis symptoms did not appear in the diagnosis is difficult, easy to diagnosis of optic neuritis, optic neuritis and optic papilla inflammation atrophy, the misdiagnosis rate was 93%. myelitis starting VEP examination is helpful in the diagnosis of cranial MRI and blood NMO-IgG. Provide strong evidence for improving the diagnosis rate and prognosis, with extensive clinical value of.NMO can be divided into single phase and multi phase For women, the late onset age and long index interval may be related to the recurrence course..NMO may be divided into two categories: external factors (environmental factors) and internal causes. In view of its complexity, large sample and multicenter long-term follow-up studies should be conducted to systematically evaluate the diagnosis and treatment of NMO.

【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.6

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