【摘要】：目的：通過對111例急性橫貫性脊髓炎患者的臨床資料進(jìn)行回顧性分析，以探討急性橫貫性脊髓炎的年齡、性別、發(fā)病誘因、臨床表現(xiàn)、腦脊液檢查、影像學(xué)檢查等方面的臨床特征以及不同治療方法的效果，從而提高對急性橫貫性脊髓炎的認(rèn)識，為早期診斷、及時(shí)選擇有效治療方法、預(yù)測預(yù)后提供依據(jù)。 方法：本研究連續(xù)收集了2008年5月至2013年12月在河北醫(yī)科大學(xué)第二醫(yī)院住院的111例急性橫貫性脊髓炎患者。所有病例均符合急性脊髓炎國際協(xié)作組（Transverse Myelitisconsortium Working Group，TMCWG）制定的ATM診斷標(biāo)準(zhǔn)。年齡為15~80歲，平均42.72±18.04歲。本研究詳細(xì)記錄了患者的年齡、性別、病前2周內(nèi)感染史、臨床表現(xiàn)、腦脊液檢查、脊髓MR檢查、神經(jīng)電生理學(xué)檢查、合并癥、治療效果。依據(jù)治療方法不同，分為地塞米松組（30例）、甲基潑尼松龍組（29例）、甲基潑尼松龍聯(lián)合丙種球蛋白組（25例），對以上三種治療方法的療效進(jìn)行對比研究，使用SPSS16.0進(jìn)行統(tǒng)計(jì)學(xué)分析，計(jì)數(shù)資料采用χ2檢驗(yàn)。三組間比較，P＜0.05為差異具有統(tǒng)計(jì)學(xué)意義；三組內(nèi)兩兩比較，P＜0.0167為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1臨床特征分析 1.1一般特征 女性70例（63.1%），男女比例為1:1.7。青年（≤44歲）56例（50.5%），中年(45~59歲)30例（27%），老年（≥60歲）25例（22.5%）。病前2周內(nèi)存在感染史者50例（45%）。 1.2臨床表現(xiàn) 運(yùn)動(dòng)障礙者108例（97.3%），其中截癱65例（60.2%），以截癱為主；感覺障礙者102例（91.9%），其中存在感覺平面者100例（98%），感覺平面非對稱者6例（6%）；自主神經(jīng)功能障礙者92例（82.9%），，其中尿潴留85例（76.6%）。 1.3輔助檢查 行腰椎穿刺者55例，其中腦脊液中白細(xì)胞升高者20例（36.4%），腦脊液中蛋白升高者29例（52.7%）；行腦脊液細(xì)胞學(xué)檢查者48例，其中異常腦脊液細(xì)胞學(xué)者38例（79.2%），以淋巴細(xì)胞反應(yīng)為主者34例，以嗜中性粒細(xì)胞反應(yīng)為主者4例；行脊髓MRI檢查者108例，其中異常93例（86.1%），病變累及頸髓者48例，病變累及胸髓者62例，病變累及腰髓者18例，病變累及骶髓者10例，脊髓水腫者39例；行脊髓MR增強(qiáng)者48例，其中33例（68.8%）脊髓病變部位存在增強(qiáng)。行視覺誘發(fā)電位檢查者34例，異常15例（44.1%）；行肌電圖檢查者12例，異常9例（75%）。 1.4合并癥 發(fā)生合并癥者28例，其中泌尿系感染20例（71.4%），呼吸道感染7例（25%），壓瘡6例（21.4%），下肢靜脈血栓3例（10.7%）。 2治療效果 地塞米松組標(biāo)準(zhǔn)化有效率為70.2%，甲強(qiáng)組標(biāo)準(zhǔn)化有效率為85.7%，甲強(qiáng)聯(lián)合丙球組標(biāo)準(zhǔn)化有效率為96.5%。三組比較，P＜0.05，可認(rèn)為三種療法治療急性橫貫性脊髓炎的有效率有差別。三組內(nèi)兩兩比較，P＜0.0167，故可認(rèn)為大劑量甲基潑尼松龍聯(lián)合丙種球蛋白的療效最佳，大劑量甲基潑尼松龍沖擊療效次之，地塞米松療效最差。 結(jié)論： 1.本研究中急性橫貫性脊髓炎患者以青年為主，女性居多；以感染后急性橫貫性脊髓炎居多。 2.大多數(shù)急性橫貫性脊髓炎患者存在運(yùn)動(dòng)障礙，以截癱為主，與急性橫貫性脊髓炎好發(fā)于胸髓相一致；多數(shù)患者存在明確的感覺障礙平面，自主神經(jīng)功能障礙以尿潴留為主。 3.急性橫貫性脊髓炎患者腦脊液檢查少見炎性證據(jù)，而脊髓MRI檢查顯示病變的陽性率高。 4.急性橫貫性脊髓炎的并發(fā)癥以泌尿系感染多發(fā)，住院期間應(yīng)注意尿液變化及會(huì)陰護(hù)理。 5.大劑量甲基潑尼松龍聯(lián)合丙種球蛋白的療效最佳，大劑量甲基潑尼松龍沖擊療效次之，地塞米松療效最差。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R744.3

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 張宏菊;;探討急性脊髓炎的臨床特征以及激素聯(lián)合中藥治療臨床效果[J];環(huán)球中醫(yī)藥;2015年S2期

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