【摘要】：目的探討老年脊髓亞急性聯(lián)合變性(subacute combined degeneration of the spinal cord,SCD)患者的病因、臨床特征、治療及預后。方法選擇17例SCD老年患者,對其病因、臨床表現(xiàn)、輔助檢查、治療及預后等進行回顧性分析。結果老年SCD患者的男女患病率無顯著差異;既往甲狀腺疾病患者6例(35.3%),胃疾病史5例(29.4%),吸煙史5例(29.4%),長期素食4例(23.5%);感覺異常15(88.2%),共濟失調癥狀12例(70.6%),精神智能癥狀12例(70.6%);體征以閉目難立征試驗陽性16例(94.1%)和位置覺、振動覺減退15例(88.2%);10例提示巨幼細胞性貧血(58.8%),6例促甲狀腺激素升高(35.3%);脊髓MRI示7例有脊髓損害表現(xiàn)(41.2%),17例治療前行神經(jīng)電生理檢測均發(fā)現(xiàn)異常(100.0%);所有患者予以甲鈷胺和維生素B1治療后均有不同程度好轉。結論老年人SCD發(fā)病與甲狀腺疾病、胃部疾病等相關;以感覺異常、共濟失調多見,易出現(xiàn)精神智能癥狀;巨幼細胞貧血陽性率高;MRI與神經(jīng)電生理檢查有助于診斷;早診斷、早治療利于預后。
[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.
【作者單位】： 贛南醫(yī)學院第一附屬醫(yī)院神經(jīng)內科;
【分類號】：R744.6

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