李莉;朱红灿;祝清勇;岳培建;梁红红;

• 1:郑州大学第一附属医院

摘要(Abstract)：

目的了解当前人们生活方式及膳食结构改变引起的脊髓亚急性联合变性(SCD)临床新特点。方法对50例SCD患者的临床资料进行回顾性分析,连续数据采用均值±标准差,分类数据用数目和百分比表示;相关分析采用Logistic回归相关分析,P<0.05为显著水平。结果 (1)发病年龄19～83岁,平均(53.2±10.8),<45岁5例(10%),45～65岁18例(36%),≥65岁27例(54%)。(2)贫血15例(30%),消化道疾病8例(16%),酗酒5例(10%),长期素食5例(10%),糖尿病饮食7例(14%),长期厌食(神经症)2例(4%),吸食N_2O 2例(4%),甲状腺疾病1例(2%)。(3)年龄>65岁、血清血红蛋白(Hb)、血清维生素B_(12)水平与本病神经系统病变的严重程度与无显著相关性(P>0.05)。平均红细胞体积(MCV)与神经功能障碍的严重程度关系密切,外周血MCV越高时神经病变越严重(P<0.05)。(4)50例(100%)神经电生理检查示不同程度的损伤,其中运动神经传导速度减慢25例(50%),感觉神经传导速度减慢40例(80%),脑干听觉诱发电位(BAEP)异常3例(6%),视觉诱发电位(VEP)2例(4%)。(5)磁共振成像发现病灶14例(28%),累及颈髓6例,累及胸髓6例,同时累及颈髓和胸髓2例,病灶累及脊髓侧索或后索,位于下颈段及胸段。结论 65岁以后可能为SCD另一发病高峰期。青少年患者无明确危险因素出现SCD表现需警惕吸食N_2O病史。血清维生素B_(12)正常或升高并不能排除SCD诊断,新的生化指标MCV、Hcy及脑脊液碱性髓鞘蛋白(MBP)的测定有助于SCD的早期诊断。神经电生理检查可以客观反映SCD病变部位,其检出率高于MRI检出率,在SCD疾病的早期诊断中具有重要价值。

关键词(KeyWords)： 脊髓亚急性联合变性;临床新特点;膳食结构;生活方式;N_2O中毒;维生素B_(12)

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 李莉;朱红灿;祝清勇;岳培建;梁红红;

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