本文選題：視神經(jīng)脊髓炎　切入點(diǎn)：Devic病　出處：《中國人民解放軍軍醫(yī)進(jìn)修學(xué)院》2010年碩士論文

【摘要】： 目的：通過對62例視神經(jīng)脊髓炎患者進(jìn)行詳細(xì)的病史采集、眼科以及神經(jīng)內(nèi)科臨床檢查、眼科輔助檢查、影像學(xué)檢查等分析,參照國際認(rèn)可的診斷標(biāo)準(zhǔn)明確診斷,并通過血液、腦脊液等實(shí)驗(yàn)室檢查指標(biāo),分析視神經(jīng)脊髓炎患者的發(fā)病過程,以減少臨床誤診和漏診。并對患者進(jìn)行長期隨訪,追蹤了解疾病的復(fù)發(fā)情況及轉(zhuǎn)歸。探討分析視神經(jīng)脊髓炎的單時(shí)相病程及多時(shí)相病程與疾病診斷、治療的關(guān)系,以期為臨床早期診斷及預(yù)后判斷提供幫助。 方法：回顧性分析2000-2009年于解放軍總醫(yī)院收治的62例視神經(jīng)脊髓炎病例,共110眼。對其臨床資料收集后分析,其中包括年齡、性別、首發(fā)癥狀、視神經(jīng)炎和脊髓炎的體征及既往診療情況進(jìn)行總結(jié)分析。患者入院后詳細(xì)詢問病史,并行視力、視野、眼底、VEP等各項(xiàng)眼科及輔助檢查,必要時(shí)行眼底熒光血管造影、MRI等影像學(xué)檢查,神經(jīng)內(nèi)科會(huì)診行常規(guī)檢查必要時(shí)做腰穿,并行血常規(guī)、血沉、血糖、肝腎功能、激素水平、類風(fēng)濕因子、免疫因子、血液NMo-IgG、腦脊液生化、常規(guī)等實(shí)驗(yàn)室檢查。根據(jù)各項(xiàng)檢查結(jié)果,參照1999年Wingerchuk等制定的診斷標(biāo)準(zhǔn)對患者明確診斷。 結(jié)果：本組視神經(jīng)脊髓炎患者中,男15例(24.2%),女47例(75.8%),男女比例1：3。發(fā)病年齡3-69歲,平均(39.44±4.28)歲,20-59歲占發(fā)病人數(shù)74%。,單眼受累14例(23%),雙眼受累48例(77%),單時(shí)相病程者15例(24.2%),多時(shí)相病程者47例(75.8%),病程最短30天,最長20年。雙側(cè)視神經(jīng)炎和脊髓炎同時(shí)或相繼很快發(fā)生,常預(yù)示單時(shí)相病程,單時(shí)相發(fā)病時(shí)臨床表現(xiàn)比復(fù)發(fā)型重,而預(yù)后好。多時(shí)相病程首發(fā)為視神經(jīng)炎或脊髓炎任一單獨(dú)事件,女性、發(fā)病年齡晚、首次發(fā)作脊髓炎運(yùn)動(dòng)障礙或視力降低相對輕是其特征(P值分別為0.057,0.122)。62例NMO均表現(xiàn)為急性或亞急性起病的單側(cè)或雙側(cè)視神經(jīng)或脊髓損害癥狀而無其他部位受損。視神經(jīng)炎病程在1-3個(gè)月的患者中視神經(jīng)萎縮發(fā)生率為67.7%,病程3個(gè)月時(shí)視神經(jīng)萎縮發(fā)生率上升到90%。病程在1-3個(gè)月和3個(gè)月組是神經(jīng)萎縮的發(fā)病率均明顯高于1個(gè)月組(P=0.011,P0.05)。43例VEP檢查結(jié)果顯示42例結(jié)果異常,異常率達(dá)98%。62例MRI結(jié)果中,脊髓損傷平面在頸段者35例(56.45%),胸段者17例(27.42%),腰段者3例(4.84%),未見異常7例(11.29%)。病灶位于頸、胸髓比率高,具有節(jié)段長易合并壞死等特點(diǎn)。 結(jié)論：NMO患者的神經(jīng)系統(tǒng)癥狀和體征局限于視神經(jīng)和脊髓,受累達(dá)100%,臨床表現(xiàn)嚴(yán)重,多呈橫貫性脊髓損害,首次發(fā)作中痛溫覺障礙明顯,預(yù)后差。其患病率逐年上升,女性患者比例高,臨床以視力下降為首發(fā)者多見,多以雙眼發(fā)病多,視力減退明顯,患眼表現(xiàn)為不同程度視野缺損、瞳孔散大、RAPD(+)。病程大于3個(gè)月患者神經(jīng)萎縮的發(fā)生率高,在未出現(xiàn)脊髓炎癥狀前確診困難,易誤診為球后視神經(jīng)炎、視神經(jīng)炎乳頭炎及視神經(jīng)萎縮,漏診率為93%。脊髓炎首發(fā)者VEP檢查有助于確診。頭顱MRI及血液NMO-IgG為提高確診率及評價(jià)預(yù)后提供了強(qiáng)有力證據(jù),具有廣泛的臨床價(jià)值。NMO可分為單時(shí)相型和多時(shí)相型,女性、發(fā)病年齡晚、索引事件間隔長可能與復(fù)發(fā)病程有關(guān)。NMO可能的病因分為外因(環(huán)境因素)與內(nèi)因兩大類,鑒于其復(fù)雜性,應(yīng)進(jìn)行大樣本、多中心的長期隨訪研究,來對NMO的診斷治療進(jìn)行系統(tǒng)評價(jià)。
[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.

【學(xué)位授予單位】：中國人民解放軍軍醫(yī)進(jìn)修學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R774.6

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